A new five-step assessment might help family doctors rule out heart disease in people with chest pain, German researchers propose.

Chest pain is common but pose a challenge for primary care doctors, who must be able to reliably distinguish whether or not the chest pain is associated with heart disease and minimize the number of patients referred to cardiologists unnecessarily.

In Monday’s issue of the Canadian Medical Association Journal, Dr. Stefan Bösner of the University of Marburg in Germany and his colleagues describe a clinical assessment method they developed called the Marburg Heart Score.

“Our findings show that the use of a simple prediction rule based exclusively on symptoms and signs can help to rule out coronary artery disease in patients presenting with chest pain in a primary care setting,” the study’s authors concluded.

The rule uses five factors that are easy to identify during a medical visit:

Age and gender.
Known clinical vascular disease.
Pain worse with exercise.
Patient assumes pain is cardiac related.
Pain not reproduced with palpitation.

When fewer than three of the five factors are found in a patient, coronary artery disease should be ruled out, Bösner’s team suggests.

Stevens and Lasserson said the new assessment method shows promise for improving the diagnosis of coronary heart disease but that more research is needed to confirm it can be safely applied without missing more severe manifestations of the disease.

New five-step assessment to rule out heart disease