Fifty Years of Death Certificates: The Framingham Heart Study

Since the Framingham Heart Study enrolled its first patient in 1948, we have learned much about the epidemiology and pathophysiology of the United States' deadliest malady: coronary heart disease. No single medical research effort has contributed more to our increased awareness and understanding of coronary artery disease than the Framingham Heart Study. The hundreds of scientific reports during the past 50 years that have been based on Framingham data have changed not only the way we think about our patients with coronary disease but also how we actually care for them. In this issue, Lloyd-Jones and colleagues [1] suggest that the Framingham Heart Study has also influenced our consideration of heart disease when determining why an individual patient has died.

The causes of death listed on death certificates are not always accurate [2-4]. When a person dies after a long, well-characterized illness, the cause of death on the death certificate is likely to be more accurate than when a death is relatively sudden and unobserved [4, 5]. Similarly, in the absence of adequate information, the more narrowly characterized the cause of death on the certificate, the more likely it is to be in error. Thus, more miscodings are likely when the cause of death is listed as acute myocardial infarction or chronic ischemic heart disease than when both of these causes of death are coded as coronary heart disease [6]. A physician may not be entirely sure whether a new acute myocardial infarction has occurred when a person dies suddenly outside of the hospital, but he or she may be relatively sure that the death was due to coronary heart disease when …