APPENDIX A
MMCC CASE LAW
1. When the death certificate is the only available document, and the ICD code is compatible with CHD (410-414, 427.5, 429.2, 799) then final ARIC classification of cause of death is usually “Possible CHD,” unless there is (I) a demonstrable coding error, or (II) an explicit non-CHD probable cause of death (such as malignant hypertension with renal failure). Analogously, for other ICD codes the classification of cause of death is usually “Non-CHD”.
2.
The
classification “Diagnosis Unclassifiable” will be reserved for cases not
meeting ARIC criteria for CHD diagnosis, but in whom a specific
non-atherosclerotic or non-cardiac atherosclerotic process cannot be identified.
3.
In the case of
conflicting information, the more inclusive cause of death (e.g., Definite CHD
rather that Definite MI) is preferred.
4.
Stroke
qualifies as a “yes” answer to “a non-atherosclerotic or non-cardiac
atherosclerotic process,” if judged to be the probably cause of death.
5. If the decedent was debilitated from a potentially lethal
non-atherosclerotic or non-cardiac process and had a related downhill course,
with no symptomatic evidence of a recent coronary event, the death is
classified a non-CHD.
6.
In cases of
“Definite” or “Probable MI,” treated or aborted with TPA or similar
clot-dissolving therapy, in which the patient dies of a direct complication or
adverse effect of this therapy (i.e., hemorrhage), a final death classification
of “Definite fatal CHD” should usually be assigned.
7.
If a patient
having an elective CABG dies as a complication of surgery, a final death
classification of “Definite fatal CHD” should usually be assigned.
8.
Generally,
“hypertensive heart disease” will not be considered a “nonatherosclerotic
cause of death”.
9.
Death is
assumed to have occurred at the time the patient stops breathing on his/her own
and does not recover.
10. Symptoms are assumed to begin when the patient changes
his/her activity. If symptoms come and go, the onset of symptoms is the time
when they crescendo, leading to death.
11. In cases where timing of symptoms or death is unknown, the
best estimate of the chronology is to be made.
12. Symptoms of CHD leading to a hospital admission for CHD are
usually considered to be related to a subsequent death from CHD, which occurs
either before discharge or within 28 days of admission, which ever occurs
first. Deaths of doubtful chronology admitted for the investigation or
treatment of CHD are classified as deaths occurring in > 24 hours if
admitted for at least 24 hours.
13. Unknown chronology of death is an institutionalized patient
is usually considered to be < 24 hours.
14. The relative credibility of conflicting witnesses is
established from all the available evidence, i.e., there is no fixed hierarchy
of credibility (such as physician overriding a lay informant). However, as a
general rule:
a.
A
knowledgeable physician takes priority for medical history.
b.
A witness
takes priority for events around death and timing of death.
15. A clinical history of ASHD or CHD counts as evidence of
previous manifestations of CHD. If the event under consideration is the first
manifestation of CHD, it does not quality as a “history” of CHD.
16. A history of CABG or coronary angioplasty at any time prior
to death is equivalent to a positive history of CHD.
17. For community surveillance events, a coroner’s listing of
causes of death (e.g. ASCVD) is interpreted only as findings at death and is
not sufficient evidence, by itself, of past history. Other non-autopsy
information, however, such as reported previous MI, may suffice as evidence of
past history.
18. Autopsy evidence of old MI or other chronic CHD may not be
used as evidence of a history of CHD in community surveillance events.