Ischemic heart disease: medical certificate of cause of death analysis

Aim. According to data from the Moscow Oblast civil registry office in 2020, to analyze medical certificates of cause of death (MCCD), where the code from “Ischemic heart disease” (IHD) (I20-I25) group is indicated as underlying cause of death (UCD).

Material and methods. A total of 23193 deaths with I20-I25 codes (UCDs) were included. We assessed the prevalence of individual IHD types, the frequency and patterns of complications, the average age of deceased persons, the proportion of women and men, place of death registration.

Results. The average age of the deceased was 73,6±12,5 (men, 68,8±10,5; women, 78,4±12,5; p<0,0001). The proportion of women who died under the age of 70 was <20%, men — >50%. Half of the deaths were registered at home, a third in a hospital, and the rest elsewhere. Taking into account age and sex, inhospital death from myocardial infarction (MI) is recorded 12 times more often than in “other forms of acute IHD”. Chronic forms of IHD were registered in 76,9% of cases; in 47,3%, such IHD form as “Atherosclerotic heart disease” was noted. The proportion of deaths from acute MI and deaths after MI was 37,3%. In 92,1% of MCCDs of “other forms of acute IHD”, “acute coronary insufficiency” is indicated. Differences in the prevalence of various IHD forms between men and women were significant (p<0,0001). In female mortality pattern, there are 3 times less deaths from other (non-MI) acute forms of IHD and almost 2 times less deaths from old myocardial infarction and cardiac aneurysm. As the immediate cause of death, heart failure was indicated in 78,9%, while among those with prior MI — in 91%. In other acute forms of IHD, acute coronary insufficiency was indicated in 89%.

Conclusion. A high proportion of deaths with unspecified acute and chronic forms of IHD as the cause of death, especially in young men, requires a comprehensive study and development by the Russian Society of Cardiology of criteria for death from various IHD forms.

1. Drapkina OM, Samorodskaya IV, Semenov VY, Zairatyants OV. Сomparative analysis of variability of mortality rates from various causes in the subjects of Russian Federation. Arkh Patol. 2020;82(3):31-7. (In Russ.) doi:10.17116/patol20208203131.

2. Boytsov SA, Samorodskaya IV, Galyavich AS, et al. Statistical, clinical and morphological classifications of coronary heart diseases — possible to unite? Russian Journal of Cardiology. 2017;(3):63-71. (In Russ.) doi:10.15829/1560-4071-2017-3-63-71.

3. Boytsov SA, Zayratiants OV, Andreev EM, Samorodskaya IV. Comparison of coronary heart disease mortality in men and women age 50 years and older in Russia and USA. Russian Journal of Cardiology. 2017;(6):100-7. (In Russ.) doi:10.15829/1560-4071-2017-6-100-107.

4. Order of the Ministry of Health of the Russian Federation No. 352n dated 04/15/2021 “On approval of accounting forms of medical documentation certifying deaths and the procedure for their issuance”. (In Russ.).

5. Nomenclature and criteria for diagnosis of ischemic heart disease. Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature. Circulation. 1979;59(3):607-9. doi:10.1161/01.cir.59.3.607.

6. Frank GA, Zayratyants OV, Shpektor AV, et al.; Russian Society of Pathologists. Formulation of pathologic diagnosis in coronary heart disease. Class IX “Diseases of the system blood circulation” ICD-10. Clinical Recommendations. Moscow, 2015. p. 36. (In Russ.) Режим доступа: https://www.google.ru/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiZ0qjgqr_wAhX5CRAIHRUOAswQFjAAegQIAxAD&url=https%3A%2F%2Fwww.volgmed.ru%2Fuploads%2Ffiles%2F2015-11%2F49580-klinicheskie_rekomendacii_po_formulirovke_patologoanatomicheskogo_diagnoza_pri_ibs.pdf&usg=AOvVaw3epA_jJ6se_eHfgLpDdy1p.

7. Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.) doi:10.15829/1560-4071-2020-4076.

8. Knuuti J, Wijns W, Saraste A, et al. Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77. doi:10.1093/eurheartj/ehz425.

9. Kunadian V, Chieffo A, Camici PG, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020;41(37):3504-20. doi:10.1093/eurheartj/ehaa503.

10. CDC WONDER. https://wonder.cdc.gov.

11. Cleland JGF, Pfeffer MA, Clark AL, et al. The struggle towards a Universal Definition of Heart Failure — how to proceed? European Heart Journal. 2021;42(24):2331-43. doi:10.1093/eurheartj/ehab082.

12. National recommendations for determining the risk and prevention of sudden cardiac death — 2018. Cardiology: News. Opinions. Training. 2019;(1):64-88. (In Russ.)