Marburg Heart Score (MHS) Calculator
Rules out coronary artery disease in patients 35 years and older presenting with chest pain in a primary care setting.
Refer to the text below the score for more information about the variables involved, the original study and further validations.
The purpose of Marburg Heart Score (MHS) is to help general practitioners rule out coronary artery disease (CAD) in patients presenting with chest pain.
It provides a structured way to assess the likelihood of CAD via 5 predictors, aiming to ensure that low-risk patients receive safe and appropriate care without unnecessary urgent referrals.
By using this score, primary care providers can make more informed decisions, improve diagnostic accuracy, and manage chest pain cases more effectively in primary care settings.
Marburg Heart Scores range from 0 to 5 and are interpreted as follows:
| MHS | CAD risk | Recommendation |
| 0 – 2 | 3% | Outpatient evaluation as needed |
| ≥3 | 23% | Consider urgent evaluation or inpatient admission |
A score of 3 or more showed a sensitivity of 87.1% in original study (89% in validation study) and a specificity of 80.8% in original study (63% in validation) for the detection of coronary artery disease (CAD) with a negative predictive value of 97% and a positive predictive value of 23%.
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About the Marburg Heart Score
The MHS is a clinical tool developed to help with ruling out coronary artery disease (CAD) in primary care patients aged 35 and older with chest pain. It is important to note that this is not for emergency settings or for patients with clear alternative causes of chest pain or definitive cardiac indicators.
Five predictive indicators have been put together:
| Marburg Heart Score | Yes | No |
| Female ≥65 years or male ≥55 years | +1 | 0 |
| Known CAD, cerebrovascular disease, or peripheral vascular disease | +1 | 0 |
| Pain worse with exercise | +1 | 0 |
| Pain reproducible with palpation | 0 | +1 |
| Patient assumes pain is cardiac | +1 | 0 |
The tool is designed as a negative predictive measure to identify patients at low risk (scores ≤2) who do not require further urgent evaluation, as these patients have a 98% likelihood of not having unstable CAD.
Conversely, scores ≥3 indicate a higher risk, warranting urgent evaluation but with only a modest 23% positive predictive value for CAD. Most chest pain cases in primary care are due to non-cardiac causes.
Clinical stability should be assessed using basic vital signs, and if other causes for chest pain are apparent, those should be addressed. Patients with signs of unstable CAD or equivalent symptoms require immediate inpatient admission.
This tool aids in determining the need for urgent versus non-urgent follow-up and testing. However, clinical judgement should always take precedence, especially for unstable patients in respiratory distress or with abnormal vital sign.
Scoring and Interpreting the MHS
Marburg Heart Scores range from 0 to 5 and are interpreted as follows:
| MHS | CAD risk | Recommendation |
| 0 – 2 | 3% | Outpatient evaluation as needed |
| ≥3 | 23% | Consider urgent evaluation or inpatient admission |
A score of 3 or more showed a sensitivity of 87.1% in original study (89% in validation study) and a specificity of 80.8% in original study (63% in validation) for the detection of coronary artery disease (CAD) with a negative predictive value of 97% and a positive predictive value of 23%.
About the Original Study and Further Validation
Bösner et al. developed and validated a simple prediction rule to identify coronary artery disease (CAD) in primary care patients presenting with chest pain. Ran across 74 primary care practices in Germany, the study included 1,249 patients in its derivation cohort.
An independent expert panel reviewed follow-up data to confirm the presence or absence of CAD. The prediction rule incorporates five determinants: age/sex, known vascular disease, patient assumption of cardiac origin of pain, pain worsening with exercise, and pain not reproducible by palpation.
The diagnostic performance of the rule was measured using receiver operating characteristic curves, with an area under the curve of 0.87 for the derivation cohort and 0.90 for the validation cohort. A cut-off score of 3 provided the best discrimination, with a sensitivity of 87.1% and specificity of 80.8%. The prediction rule proved robust and effective in primary care settings for ruling out CAD in patients with chest pain, offering a valuable tool for clinicians.
The Marburg Heart Score was further evaluated for its ability to help general practitioners (GPs) rule out coronary heart disease (CHD) in patients presenting with chest pain. Conducted in general practice settings, the study involved 56 GPs and 844 patients aged 35 and older. The study collected baseline data and tracked patient outcomes over six months. An independent expert panel reviewed the data to confirm CHD presence.
The MHS demonstrated a high area under the receiver operating characteristic curve (AUC) of 0.84, indicating good diagnostic accuracy. At a cut-off value of 3, the MHS achieved a sensitivity of 89.1% and a specificity of 63.5%, with a positive predictive value of 23.3% and a negative predictive value of 97.9%. These results support the MHS’s reliability and generalisability, recommending its use in clinical practice to manage and rule out CHD in primary care patients with chest pain.
Further studies looked into how the MHS compares against diagnostic risk stratification scores for chest pain, such as the INTERCHEST Prediction Rule and found that these tools may improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety.
References
Original reference
Stefan Bösner S, Haasenritter J, Becker A, Karatolios K, Vaucher P, Gencer B, Herzig L, Heinzel-Gutenbrunner M, Schaefer JR, Abu Hani M, Keller H, Sönnichsen AC, Baum E, Donner-Banzhoff N. Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule. CMAJ. 2010; 182(12):1295-300.
Validation
Haasenritter J, Bösner S, Vaucher P, Herzig L, Heinzel-Gutenbrunner M, Baum E, Donner-Banzhoff N. Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule. Br J Gen Pract. 2012; 62(599):e415-21.
Other references
Harskamp RE, Laeven SC, Himmelreich JC, Lucassen WAM, van Weert HCPM. Chest pain in general practice: a systematic review of prediction rules. BMJ Open. 2019; 9(2):e027081.
Manten A, De Clercq L, Rietveld RP, Lucassen WAM, Moll van Charante EP, Harskamp RE. Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care. Neth Heart J. 2023; 31(4):157-165.
Specialty: Cardiology
System: Cardiovascular
Objective: Prediction Rule
Type: Score
No. Of Items: 5
Year Of Study: 2010
Abbreviation: MHS
Article By: Denise Nedea
Published On: January 19, 2025
Last Checked: January 19, 2025
Next Review: January 19, 2030