Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule.

Details

Serval ID
serval:BIB_B9FB63F564EB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule.
Journal
British Journal of General Practice : the Journal of the Royal College of General Practitioners
Author(s)
Haasenritter J., Bösner S., Vaucher P., Herzig L., Heinzel-Gutenbrunner M., Baum E., Donner-Banzhoff N.
ISSN
1478-5242 (Electronic)
ISSN-L
0960-1643
Publication state
Published
Issued date
2012
Volume
62
Number
599
Pages
e415-e421
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Validation Studies
Abstract
BACKGROUND: The Marburg Heart Score (MHS) aims to assist GPs in safely ruling out coronary heart disease (CHD) in patients presenting with chest pain, and to guide management decisions.
AIM: To investigate the diagnostic accuracy of the MHS in an independent sample and to evaluate the generalisability to new patients.
DESIGN AND SETTING: Cross-sectional diagnostic study with delayed-type reference standard in general practice in Hesse, Germany.
METHOD: Fifty-six German GPs recruited 844 males and females aged ≥ 35 years, presenting between July 2009 and February 2010 with chest pain. Baseline data included the items of the MHS. Data on the subsequent course of chest pain, investigations, hospitalisations, and medication were collected over 6 months and were reviewed by an independent expert panel. CHD was the reference condition. Measures of diagnostic accuracy included the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and predictive values.
RESULTS: The AUC was 0.84 (95% confidence interval [CI] = 0.80 to 0.88). For a cut-off value of 3, the MHS showed a sensitivity of 89.1% (95% CI = 81.1% to 94.0%), a specificity of 63.5% (95% CI = 60.0% to 66.9%), a positive predictive value of 23.3% (95% CI = 19.2% to 28.0%), and a negative predictive value of 97.9% (95% CI = 96.2% to 98.9%).
CONCLUSION: Considering the diagnostic accuracy of the MHS, its generalisability, and ease of application, its use in clinical practice is recommended.
Keywords
Adult, Aged, Area Under Curve, Chest Pain/etiology, Coronary Disease/diagnosis, Cross-Sectional Studies, Decision Support Techniques, Diagnosis, Differential, Family Practice, Female, Humans, Male, Medical History Taking, Middle Aged, ROC Curve, Reference Standards, Sensitivity and Specificity
Pubmed
Web of science
Open Access
Yes
Create date
09/01/2015 15:46
Last modification date
20/08/2019 15:28
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