Marburg Heart Score (Marburger Herz-Score)
Rules out coronary heart disease as the cause of chest pain in primary care
- Universität Marburg (derivation)
- DEGAM S3 Brustschmerz
Sources last checked: 2026-10-13
Marburg Heart Score (Marburger Herz-Score)
Rules out coronary heart disease as the cause of chest pain in primary care
Low probability of CHD as the cause of chest pain (≈ 2.5 % in DEGAM S3 table; NPV ≈ 98 % in derivation and validation). Other causes of the chest pain move into focus; the estimate applies to the current symptoms.
Validated in primary care for chest pain as the presenting complaint, to rule OUT coronary heart disease. It is not a triage tool for acute coronary syndrome: red flags, haemodynamic instability or ECG changes are emergency findings that the score does not capture, whatever its result.
Interpretation
| 0–2 — low | Low probability of CHD as the cause of chest pain (≈ 2.5 % in DEGAM S3 table; NPV ≈ 98 % in derivation and validation). Other causes of the chest pain move into focus; the estimate applies to the current symptoms. |
|---|---|
| 3 — intermediate | Probability of CHD ≈ 17 %: intermediate; the score alone neither rules CHD out nor confirms it. |
| 4–5 — high | Probability of CHD ≈ 50 %: high. With an acute presentation, an acute coronary syndrome is among the possible causes. |
What is the Marburg Heart Score (Marburger Herz-Score)?
The Marburg Heart Score is a five-item clinical prediction rule that helps general practitioners rule out coronary heart disease in patients presenting with chest pain. It was derived by Bösner and colleagues at the University of Marburg from 1,199 German primary-care patients and published in 2010, then externally validated in an independent primary-care cohort. The German DEGAM S3 guideline on chest pain recommends it for this purpose.
When to use it
- Adults presenting to primary care with chest pain as the main complaint.
- Estimating whether coronary heart disease is an unlikely cause, so that other causes (musculoskeletal, GI, psychogenic) come into focus.
- Structuring the history in a consultation with no immediate access to troponin or imaging.
When not to use it
- Suspected acute coronary syndrome with ongoing pain, instability or ST changes — an emergency outside the scope of the score.
- Emergency department populations — it was not derived there; use HEART or guideline troponin pathways.
- Patients without chest pain as the presenting complaint.
How it is calculated
| Criterion | Points |
|---|---|
| Age/sex: woman ≥ 65 years or man ≥ 55 years | +1 |
| Known vascular disease (CAD, cerebrovascular or peripheral arterial disease) | +1 |
| Pain worse during exercise | +1 |
| Pain NOT reproducible by palpation | +1 |
| Patient assumes the pain is of cardiac origin | +1 |
Clinical pearls and limitations
- Validated in primary care for chest pain as the presenting complaint, to rule OUT coronary heart disease. It is not a triage tool for acute coronary syndrome: red flags, haemodynamic instability or ECG changes are emergency findings that the score does not capture, whatever its result.
- Its strength is the negative result: a score of 0–2 had a negative predictive value of about 98 % in derivation and validation.
- A positive score (≥ 3) is not a diagnosis — in validation only about a quarter of positive patients had CHD.
- Every item is history-based; no ECG or lab is required, which makes it useful in home visits and telephone triage follow-ups.
- Combine with clinical judgement: the GP's overall impression added value in the original studies.
Frequently asked questions
What is a positive Marburg Heart Score?
3 or more points. 0–2 points indicates a low probability of coronary heart disease as the cause of chest pain.
Is the Marburg Heart Score recommended in Germany?
Yes. The DEGAM S3 guideline 'Brustschmerz' (AWMF 053-023) recommends using it in primary care to estimate the likelihood of CHD in chest pain.
How does the Marburg Heart Score differ from the HEART score?
Marburg is for primary care and uses history only; HEART is for the emergency department and includes ECG and troponin to estimate short-term MACE risk.
Which criteria make up the Marburg Heart Score?
Age/sex (women ≥ 65, men ≥ 55), known vascular disease, pain worse on exercise, pain not reproducible by palpation, and the patient's belief that the pain is cardiac — 1 point each.
Evidence and guidelines
- Primary source: Bösner S, Haasenritter J, Becker A et al. Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule. CMAJ 2010;182(12):1295-1300.
- DEGAM S3-Leitlinie Brustschmerz (AWMF-Register 053-023), Version 2025: Empfehlung 5.3.2 und Tabelle 3.
- Haasenritter J et al. Coronary artery disease in primary care: accuracy of a simple diagnostic rule (Marburg Heart Score) — external validation. Br J Gen Pract 2012;62:e415-e421.
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the Marburg Heart Score (Marburger Herz-Score)Related calculators
Embed this calculatorFree to use on your website, intranet or teaching page. Copy the code below.
<iframe src="https://medelix.ai/en/embed/marburg-heart-score" title="Marburg Heart Score (Marburger Herz-Score) – Medelix" width="100%" height="620" style="border:0;max-width:720px" loading="lazy"></iframe>
<p><a href="https://medelix.ai/en/calculators/marburg-heart-score">Marburg Heart Score (Marburger Herz-Score) calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.