Cardiovascular disease reported as modes of death in the Office for National Statistics mortality data: a retrospective observational study

Objective: A cause of death is a specific disease or injury which directly led to the death whereas a mode of death which is a mechanism such as respiratory failure, cardiac arrest or cardiac failure but does not provide the cause of death. We sought to establish the scale of use of cardiovascular mode and other non-specific codes as causes of death. Design: We extracted the mortality statistics recorded between 2013 and 2021 and then selected cardiovascular codes. Setting: The Office for National Statistics mortality data. Participants: Deceased individuals from England and Wales. Main outcome measures: Cause of death. Results: Of 4,852,897 deaths, 836,741 (17.2%) had cardiovascular codes. Of these, 103,160 (12.3%) were labelled as modes and 35,784 (4.3%) were non-specific causes. Modes increased from 5862 in 2013 to 14,641 in 2021. Modes included 56,291 (6.7%) as arrhythmia and 46,787 (5.6%) as heart failure. Non-specific included 12,192 (1.46%) myocardial degeneration and 6573 (0.79%) cardiomegaly. Non-specific cardiomyopathies included other cardiomyopathies (207) and cardiomyopathy, unspecified (2984). Conclusions: Modes of death are being used in a notable proportion of medical certificates and this is increasing which is worrying and does not provide the underlying cause of the death. It is important that a cause of death is given so that underlying heritable cardiac conditions, such as channelopathy or cardiomyopathy, are identified. This enables referral of blood relatives for cardiological screening and intervention. ICD-11 will help address some of the non-specific causes of death with the inclusion of codes for sudden arrhythmic death syndrome and arrhythmogenic cardiomyopathy. Autopsy is essential to establish a cause of death where only a mode of death can be given without clarification of a causative disease.