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Thomas J. Thom
National Heart, Lung, and Blood Institute Bethesda, Md

JAMA. 1984;251(17):2209.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

Dr Altman's letter raises the question of whether the decline in autopsy rate that has taken place since 1965 might account for the decline in mortality from myocardial infarction and cardiovascular diseases that has been observed since 1968. The report by Zarling et al,¹ showing that a substantial fraction of autopsy-demonstrated myocardial infarctions were not diagnosed antemortem, may provoke this question, but it does not shed much light on the answer. As recognized in the report, autopsies are not done on a representative fraction of hospital deaths or deaths in the community. Furthermore, the report is vague in clarifying how often the pathologically identified myocardial infarction was the cause of death rather than a secondary or incidental finding. Nor were the clinically judged causes of death reported, so one can only speculate how frequently they were one of the other subcategories within the ischemic heart disease category . . . [Full Text PDF of this Article]

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