Debatable issues of coding chronic forms of ischemic heart disease as the primary cause of death

Aim: to examine the opinions of healthcare professionals on using codes from the ICD-10 group chronic ischemic heart disease (CIHD) (I25.0, I25.1, I25.8, I25.9) as the primary cause of death and discuss the results in the context of comparing with regional variability of standardized mortality ratio (SMR) from different forms of CIHD.
Materials and methods. A one-stage study was conducted. This article describes the results of a survey of 366 medical workers (cardiologists, internists/general practitioners/family doctors, pathologists, public health and healthcare specialists, paramedics) from 47 subjects of the Russian Federation who fill out a medical death certificate (MDS) more often than 2–3 times a month. In addition, SMR from coronary heart disease were determined based on a brief nomenclature of causes of death of Rosstat in 82 regions of the Russian Federation for 2022.
Results. 80.1 % of respondents expressed the opinion that I25.0, I25.1, I25.8, I25.9 are necessary for coding causes of death, but half of those surveyed do not see any differences in them. At the same time, respondents admit the possibility of using these CIHD codes as the primary cause of death without ante-mortem and pathological verification. The relatively small coefficient of variation of SMR overall from CIHD (34.19 per 100,000 population) is associated with high values from its individual forms: the coefficient of variation of average regional SMRs ranged from 62 % for code I25.1 to 174 % for code I25.0.
Conclusions. The results of this study indicate a variable attitude of specialists filling out MSD towards choosing ICD-10 codes from the CIHD group, leading to significant interregional differences in CIHD mortality rates. It is necessary to develop unified recommendations describing situations in which codes from the CIHD group can be considered the primary (main) cause of death.

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