The Overestimation of Heart Failure in Cause-of-Death Statistics

Abstract

Heart Failure is one of the top ten leading causes of death in mortality statistics. Mortality statistics report underlying causes of death, i.e. starting points of causal chains leading to death. Heart failure always has a cause and therefore cannot be such a starting point. Therefore, the aim of this study is to explain the occurrence of heart failure in mortality statistics. Survey among a sample of 750 certifiers who mentioned heart failure on a death certificate. Comparison of the physician's opinion on the role of heart failure as a cause of death with the outcome of automated coding for statistics. The survey response was 56%. When a doctor mentions heart failure on a death certificate, the disease is considered underlying cause of death in 21.4% of the cases. In statistics, the disease is assigned this role in 39.2% of the (same) cases. Heart failure is overestimated by 17.8 percentage points or 45% (95%-CI: 40-50%) in mortality statistics. In cause-of-death statistics, heart failure is more often regarded as underlying cause of death than intended by the certifying physician. This overestimation is caused by incorrectly completed death certificates, conceptual confusion and a real difference in opinion on the role of heart failure as underlying cause of death.