Exploring postmortem practices for cardiac device interrogation in the UK.

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.