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The Research Question

The Research Question Has this patient with chest pain coronary artery disease? Diagnostic utility of a clinical decision rule. J Haasenritter, S Bösner, N Donner-Banzhoff (Philipps University Marburg, Germany)

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The Research Question

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  1. The Research Question Has this patient with chest pain coronary artery disease? Diagnostic utility of a clinical decision rule.J Haasenritter, S Bösner, N Donner-Banzhoff (Philipps University Marburg, Germany) • Question: What is the diagnostic utility of the Marburg Heart Score (MHS) in terms of improving the accuracy of the GP‘s initial clinical diagnosis? • Why this is important? • GPs must identify patients with CAD while avoiding unnecessary testing and hospital admissions in the large majority of patients with non-cardiac pain. • The Marburg Heart Score (MHS) is an easy to use, valid, and robust tool for ruling out CAD in chest pain patients. (Bösner et al. 2010, Haasenritter et al. 2012) • Its impact on improving the GP’s initial clinical diagnosis is unclear.

  2. What the Researchers Did • Population/Subjects: 832 consecutive patients aged ≥ 35 years presenting with chest pain in primary care/56 general practitioners (GPs) • Design: Comparative diagnostic accuracy study • Basic Method/Intervention • Comparative test: GP’s unaided clinical judgment based on history and physical examination. • New/ index tests: 1) Marburg Heart Score (MHS); 2) GP’s aided clinical judgment based on history, physical examination and results of the MHS; 3) Using the MHS as a triage, only patients with a score value of 3 were further assessed by GPs. • Reference diagnosis was established using a delayed-type reference standard in combination with an independent expert panel.

  3. Marburg Heart Score (MHS) • Easy touse, valid and robust toolforruling out CAD in chestpainpatients • Bösner et al. CMAJ 2010;182:1295 • Haasenritter et al. Br J Gen Pract. 2012;62:e415

  4. What the Researchers Found

  5. What This Means for Clinical Practice • Results of the current study suggest that using the MHS may improve the accuracy of the GP’s clinical diagnosis. • Considering also other aspects of the MHS (simplicity) and previous study results (validity, robustness) we recommend the MHS as a useful tool for ruling out CAD in chest pain patients in primary care.

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