Clinical information has low sensitivity for postmortem diagnosis of heart valve disease.
Accuracy of routinely collected information concerning cause of death is essential for public health and health systems planning. Since clinical examination has relatively low sensitivity for detection of valvular heart disease (VHD), mortality data based on clinical information alone might routinely underestimate the number of deaths due to VHD.



We compared autopsy findings against premortem clinical information for 8198 consecutive adult postmortems (mean age 69.1 years, 61.3% men), performed in a single UK tertiary referral centre with on-site cardiac surgical facilities over a 10-year period (2004-2013) during which 21% of the adult population underwent postmortem examination.



Following postmortem, VHD was the principal cause of death in 165 individuals (2.0%), a principal or contributory cause ('any cause') of death in 326 (4.0%) and an incidental (ie, non-causal) finding in a further 346 (4.2%). Clinical documentation of VHD before death was highly specific but relatively insensitive for postmortem identification of VHD as the principal (specificity 96.8%; 95% CI 96.4% to 97.2%; sensitivity 69.7%, 95% CI 62.1% to 76.6%) or any (specificity 98.1%; 95% CI 97.8% to 98.4%; sensitivity 68.4%, 95% CI 63.1% to 73.4%) cause of death. VHD (principally aortic stenosis, endocarditis and rheumatic heart disease) was newly noted at postmortem and listed as a cause of death in 142 individuals (1.7%).



Clinical information recorded premortem is highly specific but relatively insensitive for the cause of death established at autopsy. Population-based mortality statistics that depend on premortem clinical information are likely to routinely underestimate the mortality burden of VHD.
National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK.|Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St Leonards, Australia.
Sean
S
Coffey
National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK.|Royal Brompton and Harefield NHS Foundation Trust, London, UK.|Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
Andrew R
AR
Harper
Cancer Epidemiology Unit, University of Oxford, Oxford, UK.|British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK.
Benjamin J
BJ
Cairns
Department of Cellular Pathology, Oxford University Hospitals NHS Trust, Oxford, UK.
Ian Sd
IS
Roberts
Department of Cardiology, St Thomas' Hospital, London, UK.
Bernard D
BD
Prendergast
D000368:Aged; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death / Q000639:trends; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
autopsy; death certificates; epidemiology; mortality; valvular heart disease