Copyright © 1998 by the European Society of Cardiology.
Importance of heart failure as a cause of death. Changing contribution to overall mortality and coronary heart disease mortality in Scotland 1979–1992
a Medical Research Council’s Clinical Research Initiative in Heart Failure, University of Glasgow, Glasgow, Scotland, U.K.
b Department of Biostatistics, University of Glasgow, Glasgow, Scotland, U.K.
c Department of Public Health, University of Glasgow, Glasgow, Scotland, U.K.
accepted July 27, 1998
Aims
As heart failure is a syndrome arising from another condition, such as coronary heart disease, it is rarely officially coded as the underlying cause of death regardless of the cause recorded by the physician at the time of certification. We sought to assess the true contribution of heart failure to overall mortality and coronary heart disease mortality and to examine how this contribution has changed over time.
Methods and Results
We carried out a retrospective analysis of all death certificates in Scotland between 1979 and 1992 for which heart failure was coded as the under-lying or a contributory cause of death. From a total of 833622 deaths in Scotland between 1979 and 1992, heart failure was coded as the underlying cause in only 1·5% (13695), but as a contributory cause in a further 14·3% (126073). In 1979, 28·5% of male and 40·4% of female deaths attributed to coronary heart disease (coded as the underlying cause of death) also had a coding for heart failure. In 1992 these percentages had risen significantly to 34·1% and 44·8%, respectively (bothP<0·001). Mortality rates for heart failure as the underlying or contributory cause of death, standardized by age and sex, fell significantly over the period studied in all ages and in both sexes: by 31% in men and 41% in women <65 years and 15·8% in men and 5·1% in women 
65 years, respectively (P<0·01 for all changes).
Conclusions
Death from heart failure is substantially underestimated by official statistics. Furthermore, one third or more of deaths currently attributed to coronary heart disease may be related to heart failure and this proportion appears to be increasing. While the absolute numbers of deaths caused by heart failure remains constant, this study is the first to show that standardized mortality rates are declining.
Key Words: Heart failure • mortality • death certification • coronary heart disease
f1 Correspondence: Dr David R. Murdoch, BMSc, MBChB MRCP(UK), MRC Clinical Research Initiative in Heart Failure, West Medical Building, University of Glasgow, Glasgow G12 8QQ, Scotland, U.K.
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