[ { "phenotype_id": "PH687", "phenotype_version_id": 1374, "name": "Heart Failure (P5)", "definition": "Study question:\n\nWhat is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?\n\n\nMethods:\n\nA cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin.\n\n\nStudy answer and limitations:\n\n49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in patients receiving warfarin.\n\n\nWhat this study adds:\n\nThe high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Ashcroft, Examining variations in prescribing safety in UK general practice cross sectional study using the Clinical Practice Research Datalink. BMJ, 351(h5501), 2015." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:30:13.254632Z", "author": "S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Aschroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:30:13.254661Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "Start - 01/02/2013", "concept_information": [ { "concept_id": 2107, "concept_version_id": 5352, "concept_name": "Heart Failure (P5) - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH687", "phenotype_version_id": 1374, "phenotype_name": "Heart Failure (P5)", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "G1yz100", "description": "Rheumatic left ventricular failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G58..00", "description": "Heart failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580.00", "description": "Congestive heart failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580000", "description": "Acute congestive heart failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580100", "description": "Chronic congestive heart failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580.11", "description": "Congestive cardiac failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580.12", "description": "Right heart failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580.13", "description": "Right ventricular failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580.14", "description": "Biventricular failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580200", "description": "Decompensated cardiac failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580300", "description": "Compensated cardiac failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G580400", "description": "Congestive heart failure due to valvular disease", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G581.00", "description": "Left ventricular failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G581000", "description": "Acute left ventricular failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G58..11", "description": "Cardiac failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G581.11", "description": "Asthma - cardiac", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G581.12", "description": "Pulmonary oedema - acute", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G581.13", "description": "Impaired left ventricular function", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G582.00", "description": "Acute heart failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G583.00", "description": "Heart failure with normal ejection fraction", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G583.11", "description": "HFNEF - heart failure with normal ejection fraction", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G583.12", "description": "Heart failure with preserved ejection fraction", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G584.00", "description": "Right ventricular failure", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G58z.00", "description": "Heart failure NOS", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G58z.11", "description": "Weak heart", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "G58z.12", "description": "Cardiac failure NOS", "attributes": { "Entity type": "res25: P5_heart_failure", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/63zm-ez84", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1374, "version_name": "Heart Failure (P5)", "version_date": "2021-10-06T16:30:13.276614Z", "is_published": true, "is_latest": true } ] } ]