[
  {
    "phenotype_id": "PH869",
    "phenotype_version_id": 1817,
    "name": "Palliative and end of life care",
    "definition": "Background: \n\nStudies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.\n\n\nMethods: \n\nThis cohort study used English primary care electronic medical records, hospital admission records, and mortality data from the Clinical Practice Research Datalink (CPRD), for the period 01 January 2005 to 30 November 2018. It included people aged 18–99 years with depression first prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine (5081), a different SSRI (15,032), amitriptyline (3905), or venlafaxine (1580). Follow-up was from starting to stopping the second antidepressant, with a 6-month wash-out window, censoring at the end of CPRD follow-up or 30 November 2018. Age-sex standardised rates of all-cause mortality and death due to circulatory system disease, cancer, or respiratory system disease were calculated. Survival analyses were performed, accounting for baseline characteristics using inverse probability of treatment weighting.\n\n\nResults: \n\nThe cohort contained 25,598 people (median age 41 years). The mirtazapine group had the highest standardised mortality rate, with an additional 7.8 (95% confidence interval (CI) 5.9–9.7) deaths/1000 person-years compared to the SSRI group. Within 2 years of follow-up, the risk of all-cause mortality was statistically significantly higher in the mirtazapine group than in the SSRI group (weighted hazard ratio (HR) 1.62, 95% CI 1.28–2.06). No significant difference was found between the mirtazapine group and the amitriptyline (HR 1.18, 95% CI 0.85–1.63) or venlafaxine (HR 1.11, 95% CI 0.60–2.05) groups. After 2 years, the risk was significantly higher in the mirtazapine group compared to the SSRI (HR 1.51, 95% CI 1.04–2.19), amitriptyline (HR 2.59, 95% CI 1.38–4.86), and venlafaxine (HR 2.35, 95% CI 1.02–5.44) groups. The risks of death due to cancer (HR 1.74, 95% CI 1.06–2.85) and respiratory system disease (HR 1.72, 95% CI 1.07–2.77) were significantly higher in the mirtazapine than in the SSRI group.\n\n\nConclusions: \n\nMortality was higher in people prescribed mirtazapine than people prescribed a second SSRI, possibly reflecting residual differences in other risk factors between the groups. Identifying these potential health risks when prescribing mirtazapine may help reduce the risk of mortality.\n\n\n\n\n\n\n\n\n",
    "implementation": "",
    "publications": [
      {
        "doi": null,
        "details": "Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland, The risk of all-cause and cause-specific mortality in people prescribed mirtazapine an active comparator cohort study using electronic health records. BMC Medicine, 20(43), 2022."
      }
    ],
    "validation": "",
    "citation_requirements": "",
    "created": "2022-04-04T07:07:21.534749Z",
    "author": "Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland",
    "collections": [
      {
        "name": "ClinicalCodes Repository",
        "value": 25
      },
      {
        "name": "Phenotype Library",
        "value": 18
      }
    ],
    "tags": null,
    "organisation": null,
    "world_access": 1,
    "updated": "2022-04-04T07:07:21.534775Z",
    "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": "01/01/2005 - 30/11/2018",
    "concept_information": [
      {
        "concept_id": 2619,
        "concept_version_id": 6651,
        "concept_name": "Palliative and end of life care - Primary Care",
        "coding_system": {
          "id": 5,
          "name": "Read codes v2",
          "description": "Read codes v2"
        },
        "phenotype_id": "PH869",
        "phenotype_version_id": 1817,
        "phenotype_name": "Palliative and end of life care",
        "code_attribute_header": [
          "Entity type",
          "Category",
          "Coding System (Read)"
        ],
        "codes": [
          {
            "code": "66S3.00",
            "description": "full care by hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "66S4.00",
            "description": "shared care - hospice / gp",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8B2a.00",
            "description": "prescription of palliative care anticipatory medication",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BA2.11",
            "description": "end of life care",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAe.00",
            "description": "anticipatory palliative care",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAN.00",
            "description": "community specialist palliative care",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAP.00",
            "description": "specialist palliative care",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAQ.00",
            "description": "final days pathway",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAR.00",
            "description": "specialist palliative care treatment - inpatient",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAS.00",
            "description": "specialist palliative care treatment - daycare",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BAT.00",
            "description": "specialist palliative care treatment - outpatient",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BJ1.00",
            "description": "palliative treatment",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BMM.00",
            "description": "issue of palliative care anticipatory medication box",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8BMM.11",
            "description": "issue of palliative care just in case box",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8CM1.00",
            "description": "on gold standards palliative care framework",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8CMW300",
            "description": "end of life care pathway",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H7g.00",
            "description": "referral to palliative care service",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8Hg0.00",
            "description": "discharged from community specialist palliative care team",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8Hga.00",
            "description": "discharge from hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HgX.00",
            "description": "discharge from palliative care service",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HH7.00",
            "description": "referred to community specialist palliative care team",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HX..00",
            "description": "admission to hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HX0.00",
            "description": "urgent admission to hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HX1.00",
            "description": "routine admission to hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HX2.00",
            "description": "admission to hospice for respite",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HY..00",
            "description": "referral to hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "949A.00",
            "description": "patient died in hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "949G.00",
            "description": "patient died in hospice community lodge",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9b1B.00",
            "description": "hospice - nhs",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9b1C.00",
            "description": "hospice - independent",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9b74.00",
            "description": "hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9b74000",
            "description": "hospice community lodge",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9b9B.00",
            "description": "palliative medicine",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9c0L000",
            "description": "planned palliative oncology treatment",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9c0P.00",
            "description": "current palliative oncology treatment",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9e02.00",
            "description": "notif to primary care oohs of palliative care plan in place",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9Ng7.00",
            "description": "on end of life care register",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9NgD.00",
            "description": "under care of palliative care service",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9Nh0.00",
            "description": "under the care of community palliative care team",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9NkJ.00",
            "description": "seen in hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9NlJ.00",
            "description": "seen by palliative care service",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9NNd.00",
            "description": "under care of palliative care specialist nurse",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9NNf000",
            "description": "under care of palliative care physician",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "9NNZ.00",
            "description": "has end of life care pathway key worker",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "M270300",
            "description": "hospice acquired pressure ulcer",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "Z172.00",
            "description": "palliative care",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL18R00",
            "description": "under care of palliative care physician",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5AP00",
            "description": "referral to palliative care physician",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL9AR00",
            "description": "seen by palliative care physician",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZLD3R00",
            "description": "discharge by palliative care physician",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZLE6P00",
            "description": "discharge from palliative care service",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZLF1.00",
            "description": "discharge from hospice",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZLF1100",
            "description": "discharge from hospice day hospital",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZV57C00",
            "description": "[v]palliative care",
            "attributes": {
              "Entity type": "res176: Palliative and end of life care",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          }
        ]
      }
    ],
    "status": 2,
    "doi": "https://doi.org/10.48533/wthg-fs04",
    "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": 1817,
        "version_name": "Palliative and end of life care",
        "version_date": "2022-04-04T07:07:21.561701Z",
        "is_published": true,
        "is_latest": true
      }
    ]
  }
]