Is "Sudden Cardiac Death due to Coronary Artery Disease" a Plausible Cause of Death?
Yes, this is an entirely plausible and medically appropriate cause of death, particularly in patients over 65 years with known coronary artery disease and hypertension. 1
Definition and Medical Validity
Sudden cardiac death (SCD) is formally defined as "natural death due to cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute symptoms" where the time and mode of death are unexpected. 1 This represents a legitimate medical diagnosis that should be documented on death certificates when appropriate. 1
For patients over 65 years with known coronary artery disease, sudden cardiac death is the most common mode of death, accounting for the overwhelming majority of cardiac deaths in this age group. 1 Autopsy studies confirm that approximately two-thirds of sudden non-traumatic deaths in middle-aged and elderly subjects are cardiac in origin, with coronary artery disease responsible for most of these cases. 1
Proper Death Certificate Documentation
The correct approach to documenting this cause of death follows a specific hierarchy: 1, 2
- Immediate cause of death: Sudden Cardiac Death 1, 2
- Underlying cause of death: Coronary Artery Disease 1, 2
- Contributing factors: Hypertension (if present) should be listed as a contributing factor rather than the underlying cause 1, 2
This documentation structure is critical because it identifies the specific disease that initiated the chain of events leading to death, rather than just terminal events or mechanisms. 2
Clinical Context and Mechanism
Out-of-hospital coronary heart disease death accounts for 50% to 75% of all fatal cardiovascular disease events in countries where it is documented. 3, 2 The mechanism is typically ventricular fibrillation, which occurs in 75-80% of cases presenting with sudden cardiovascular collapse and is commonly associated with underlying coronary artery disease. 1
For unwitnessed deaths where the patient was seen alive and clinically stable within 24 hours before being found dead, without evidence supporting a specific non-cardiovascular cause, sudden cardiac death should be recorded. 1, 2 This guideline from the American Heart Association provides clear criteria for when this diagnosis is appropriate even without direct observation of the terminal event. 1
Common Pitfalls to Avoid
Do not list "Heart Failure" as the underlying cause of death, as this affects the quality of vital statistics and obscures the true underlying pathology. 1 Instead, the underlying cause should be the specific disease process (coronary artery disease) that led to the cardiac event. 1
Hypertension should be documented as a contributing factor because it exacerbates atherosclerosis and contributes to plaque instability, but it is not typically the direct cause of sudden death. 1 The proper hierarchy places coronary artery disease as the underlying cause with hypertension as contributory. 1, 2
When This Diagnosis Is Most Appropriate
This cause of death is particularly plausible when: 1, 2
- The patient has documented coronary artery disease
- The patient has cardiovascular risk factors (hypertension, hyperlipidemia)
- Death occurred suddenly and unexpectedly
- The patient was seen alive within 24 hours prior to death
- No clear non-cardiovascular cause is evident
The diagnosis remains valid even without autopsy confirmation, as the clinical context and known medical history provide sufficient evidence for this determination. 1, 2