Death certificate data
In the United States an analysis of death certificates estimated that the overall SCD rate in 1999 was 3 per 100,000 from birth to age 34 (3,976 deaths), 75 per 100,000 (78,456 deaths) in the 35 to 64 year age group and 1,100 per 100,000 (379,869 deaths) in those aged 65 years or older.4 Of all SCDs in 1998 in those aged 35 or over, CHD was the underlying cause on 62% of death certificates.
The analyses in the US found that 63% of all cardiac deaths were SCDs, occurring out-ofhospital (47%), or in emergency departments or ‘dead on arrival’ (16%), with almost all of the remaining cardiac deaths occurring as non-sudden deaths in hospital.4 SCD accounted for 74% of all cardiac deaths in the 35 to 44 year age group, 73% in those 45 to 54, 66% in those 55 to 64, 58% in those 65 to 74 and 69% in those aged 85 or over.5 Between 1989 and 1998, rates of SCD in those aged over 35 years decreased by 12% in men and by 6% in women.
According to the CSO, 11,652 people died of diseases of the circulatory system in 2002 in Ireland (10,608 in 2004), including 8,126 deaths attributed to cardiac causes.* Assuming that, as in the United States, 63% of cardiac deaths are SCDs, this would translate into 5,119 such deaths in Ireland in 2002. Apart from this method of estimation, it is not possible at present to obtain the number of SCDs from Irish vital statistics reports.
In Ireland data on all deaths is collected by the Central Statistics Office (CSO), on the basis of medical certificates and death registration information collected by local Registrars’ Offices or on the basis of Coroners’ report forms. Death rates for a particular condition are estimated from the information recorded on death certificates and subsequently coded by the CSO. This information is subject to inaccuracies for a variety of reasons. For many causes of death the data are sufficiently accurate for the purposes of identifying high risk groups, tracking trends and planning health services. The nature of SCD makes it more subject to misclassification than other causes of death.
Currently the CSO is using the Ninth Revision of the International Classification of Diseases (ICD). Code 410 (acute myocardial infarction) is the most frequently used code when SCD occurs. The code for ‘cardiac arrest’ or ‘cardiorespiratory arrest’, code 427 is not used in this country, though 463 deaths in 2002 were coded as 427, ‘cardiac dysrhythmias’. Code 798, sudden death, cause unknown, was used for 48 deaths in that year.
The CSO has informed the Task Force that it plans to introduce ICD Version 10 for coding cause of death. This version has a specific code for Sudden Cardiac Death (146.1). Relevant ICD-9 and ICD-10 codes are listed in Appendix 3.
Attempting to quantify the incidence of SCD without a specific code is unsatisfactory. Instructions to those completing a death certificate do not allow use of the term SCD. Instructions on death certificates in Ireland forbid recording the mode of death, such as cardiac arrest. Instead, the certifier must state the underlying cause e.g. acute myocardial infarction (AMI).
For the purposes of completing death certificates from which national statistics are compiled, SCD is therefore coded according to its likely underlying cause, including AMI, coronary thrombosis, angina, heart failure, pulmonary oedema (fluid in the lungs), ruptured aortic aneurysm (a split in the wall of the main blood vessel from the heart), or myocarditis (infection of the muscle of the heart). A post-mortem is not carried out in all cases and so a ‘best guess’ may be made as to the underlying cause of death. Even where a post-mortem is carried out, there may be difficulty in identifying the cause of death.
With the introduction of ICD-10 it will be possible to estimate the total number of SCDs from death certificate data. In calculating the number of SCD cases it will be important to exclude victims who were not actively resuscitated because of end stage disease. These cases are not relevant to planning emergency medical services in the community.
A number of countries such as the USA, France and Italy, now include a ‘tick box’ to record cardiac arrest on the death certificate. Similar information for this country would contribute to planning and evaluation of pre-hospital and hospital care of cardiac arrest, as well as the prevention of SCD. Death certificate data will not include those who survive a cardiac arrest. Although this number is currently small, it is likely to grow over the coming years. Such data could be collected in a cardiac arrest registry (see Sections 2.2.3 and 6.4).
The analyses in the US found that 63% of all cardiac deaths were SCDs, occurring out-ofhospital (47%), or in emergency departments or ‘dead on arrival’ (16%), with almost all of the remaining cardiac deaths occurring as non-sudden deaths in hospital.4 SCD accounted for 74% of all cardiac deaths in the 35 to 44 year age group, 73% in those 45 to 54, 66% in those 55 to 64, 58% in those 65 to 74 and 69% in those aged 85 or over.5 Between 1989 and 1998, rates of SCD in those aged over 35 years decreased by 12% in men and by 6% in women.
According to the CSO, 11,652 people died of diseases of the circulatory system in 2002 in Ireland (10,608 in 2004), including 8,126 deaths attributed to cardiac causes.* Assuming that, as in the United States, 63% of cardiac deaths are SCDs, this would translate into 5,119 such deaths in Ireland in 2002. Apart from this method of estimation, it is not possible at present to obtain the number of SCDs from Irish vital statistics reports.
In Ireland data on all deaths is collected by the Central Statistics Office (CSO), on the basis of medical certificates and death registration information collected by local Registrars’ Offices or on the basis of Coroners’ report forms. Death rates for a particular condition are estimated from the information recorded on death certificates and subsequently coded by the CSO. This information is subject to inaccuracies for a variety of reasons. For many causes of death the data are sufficiently accurate for the purposes of identifying high risk groups, tracking trends and planning health services. The nature of SCD makes it more subject to misclassification than other causes of death.
Currently the CSO is using the Ninth Revision of the International Classification of Diseases (ICD). Code 410 (acute myocardial infarction) is the most frequently used code when SCD occurs. The code for ‘cardiac arrest’ or ‘cardiorespiratory arrest’, code 427 is not used in this country, though 463 deaths in 2002 were coded as 427, ‘cardiac dysrhythmias’. Code 798, sudden death, cause unknown, was used for 48 deaths in that year.
The CSO has informed the Task Force that it plans to introduce ICD Version 10 for coding cause of death. This version has a specific code for Sudden Cardiac Death (146.1). Relevant ICD-9 and ICD-10 codes are listed in Appendix 3.
Attempting to quantify the incidence of SCD without a specific code is unsatisfactory. Instructions to those completing a death certificate do not allow use of the term SCD. Instructions on death certificates in Ireland forbid recording the mode of death, such as cardiac arrest. Instead, the certifier must state the underlying cause e.g. acute myocardial infarction (AMI).
For the purposes of completing death certificates from which national statistics are compiled, SCD is therefore coded according to its likely underlying cause, including AMI, coronary thrombosis, angina, heart failure, pulmonary oedema (fluid in the lungs), ruptured aortic aneurysm (a split in the wall of the main blood vessel from the heart), or myocarditis (infection of the muscle of the heart). A post-mortem is not carried out in all cases and so a ‘best guess’ may be made as to the underlying cause of death. Even where a post-mortem is carried out, there may be difficulty in identifying the cause of death.
With the introduction of ICD-10 it will be possible to estimate the total number of SCDs from death certificate data. In calculating the number of SCD cases it will be important to exclude victims who were not actively resuscitated because of end stage disease. These cases are not relevant to planning emergency medical services in the community.
A number of countries such as the USA, France and Italy, now include a ‘tick box’ to record cardiac arrest on the death certificate. Similar information for this country would contribute to planning and evaluation of pre-hospital and hospital care of cardiac arrest, as well as the prevention of SCD. Death certificate data will not include those who survive a cardiac arrest. Although this number is currently small, it is likely to grow over the coming years. Such data could be collected in a cardiac arrest registry (see Sections 2.2.3 and 6.4).
posted by AED Ireland at
11:32 AM
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