{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T06:15:46Z","timestamp":1793513746715,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"13","funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u20132013) during which 21% of the adult population underwent postmortem examination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following postmortem, VHD was the principal cause of death in 165 individuals (2.0%), a principal or contributory cause (\u2018any cause\u2019) of death in 326 (4.0%)\u2009and 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%\u2009CI 96.4% to 97.2%; sensitivity 69.7%, 95%\u2009CI 62.1% to 76.6%) or any (specificity 98.1%; 95%\u2009CI 97.8% to 98.4%; sensitivity 68.4%, 95%\u2009CI 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%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/heartjnl-2016-310718","type":"journal-article","created":{"date-parts":[[2017,2,10]],"date-time":"2017-02-10T01:40:21Z","timestamp":1486690821000},"page":"1031-1035","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Clinical information has low sensitivity for postmortem diagnosis of heart valve disease"],"prefix":"10.1136","volume":"103","author":[{"given":"Sean","family":"Coffey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R","family":"Harper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J","family":"Cairns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian SD","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard D","family":"Prendergast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,2,9]]},"reference":[{"key":"2021102902300574000_103.13.1031.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.128413"},{"key":"2021102902300574000_103.13.1031.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002123"},{"key":"2021102902300574000_103.13.1031.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw229"},{"key":"2021102902300574000_103.13.1031.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.12.030"},{"key":"2021102902300574000_103.13.1031.5","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.205096"},{"key":"2021102902300574000_103.13.1031.6","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1161\/CIR.0000000000000029","article-title":"AHA\/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"2014","author":"Nishimura","year":"2014","journal-title":"Circulation"},{"key":"2021102902300574000_103.13.1031.7","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"key":"2021102902300574000_103.13.1031.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(96)00200-7"},{"key":"2021102902300574000_103.13.1031.9","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2006.103093"},{"key":"2021102902300574000_103.13.1031.10","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.55.7.499"},{"key":"2021102902300574000_103.13.1031.11","unstructured":"Ministry of justice. Coroners statistics 2014. https:\/\/www.gov.uk\/government\/statistics\/coroners-statistics-2014 (accessed 29 Nov 2016)."},{"key":"2021102902300574000_103.13.1031.12","unstructured":"World Health Organization. International statistical classification of diseases and related health problems\u00a010th revision. edition 2010. Geneva: BMJ Publishing Group, 2011."},{"key":"2021102902300574000_103.13.1031.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"2021102902300574000_103.13.1031.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.074"},{"key":"2021102902300574000_103.13.1031.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00067-7"},{"key":"2021102902300574000_103.13.1031.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.11.1317"},{"key":"2021102902300574000_103.13.1031.17","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(79)90077-8"},{"key":"2021102902300574000_103.13.1031.18","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1038\/nrg4017","article-title":"Protective alleles and modifier variants in human health and disease","volume":"16","author":"Harper","year":"2015","journal-title":"Nat Rev Genet"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2016-310718","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T09:32:17Z","timestamp":1635499937000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2016-310718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,9]]},"references-count":18,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2017,6,14]]},"published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1136\/heartjnl-2016-310718"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2016-310718","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,9]]}}}