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Exploring postmortem practices for cardiac device interrogation in the UK
Holly Morgan1, Tesfamariam Betemariam1, Matthew Ryan1,2
1Cardiovascular medicine, King's College London, London, England, UK.
Insights
Postmortem interrogation of cardiac implantable electronic devices (CIEDs) is rarely performed in UK NHS mortuaries, despite 5% of deaths involving these devices. Documentation and communication of findings are inconsistent, hindering understanding of sudden cardiac death causes.
Area of Science:
- Cardiology
- Forensic Medicine
- Medical Device Technology
Background:
- Sudden death investigations are challenging, especially in patients with cardiac history.
- Cardiac implantable electronic devices (CIEDs) are common, but postmortem interrogation practices are unclear.
- Understanding the role of CIEDs in sudden death requires consistent postmortem data.
Purpose of the Study:
- To assess the frequency and consistency of postmortem CIED interrogation in UK National Health Service (NHS) trusts.
- To determine how postmortem CIED data is documented and utilized by clinical teams and coroners.
- To identify gaps in current practices for investigating sudden death in patients with CIEDs.
Main Methods:
- A 5-year survey of 173 UK NHS trusts using freedom of information requests.
- Data collection focused on the proportion of deaths with CIEDs, postmortem interrogation capacity, and frequency.
- Analysis of how interrogation findings were recorded and communicated.
Main Results:
- 48% of NHS sites responded; 90% had both mortuary and cardiac physiology departments.
- An estimated 5% of deaths involved a CIED.
- Routine postmortem CIED checks were performed by only 20% of sites with cardiac physiology, with inconsistent documentation (20%) and communication (13%).
Conclusions:
- CIEDs are present in approximately 1 in 20 deaths reviewed in NHS mortuaries.
- Routine postmortem CIED interrogation is infrequent and inconsistently documented.
- Standardized postmortem interrogation protocols are needed to improve sudden death investigations.
Introduction:
Ascertaining the cause of sudden death is often difficult, even in patients with a history of heart disease. Device interrogation is routinely carried out to determine the nature of symptoms or aborted sudden death episodes in patients with cardiac implantable electronic devices (CIED), but it is not clear how often this is done postmortem, and if so, how this information is recorded and used by clinical teams and coroners.
Methods:
We determined the proportion of deaths with a CIED in situ, the capacity for and frequency of postmortem device interrogation and when done, how the information was used over a 5-year period in the UK by surveying 173 National Health Service (NHS) trusts via a freedom of information request.
Results:
A response was received from 83 (48%) NHS sites, 75 (90%) of which reported having both a mortuary and cardiac physiology department onsite. During the period 2019-2024, each mortuary handled 2400±1094 deaths per annum, of which an estimated 5±2% had a CIED in place. Of those with cardiac physiology on site, only 15 (20%) reported routine postmortem device checks were performed. If such a check was conducted, 3 out of 15 (20%) responded that findings were documented in the medical records and 2 out of 15 (13%) stated information was relayed to the medical team.
Conclusion:
Although 1 in 20 patients who present to NHS mortuaries have a CIED in situ, routine postmortem checks are performed rarely and inconsistently documented. Prospective studies are warranted to determine the feasibility and utility of standardised postmortem device interrogation.
