[ { "phenotype_id": "PH876", "phenotype_version_id": 1831, "name": "Congestive Heart Disease", "definition": "Background:\n\nSelf-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.\n\n\nMethods:\n\nThe UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.\n\n\nFindings:\n\nOverall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.\n\n\nInterpretation: \n\nWithin primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018." } ], "validation": "", "citation_requirements": "", "created": "2022-04-04T07:07:55.411865Z", "author": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2022-04-04T07:07:55.411890Z", "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": "ICD10 codes", "value": 4 }, { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/2001 - 31/12/2014", "concept_information": [ { "concept_id": 2632, "concept_version_id": 6677, "concept_name": "Congestive Heart Disease - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH876", "phenotype_version_id": 1831, "phenotype_name": "Congestive Heart Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "14A6.00", "description": "H/O: heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "14AM.00", "description": "H/O: Heart failure in last year", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "1O1..00", "description": "Heart failure confirmed", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "662W.00", "description": "Heart failure annual review", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "8B29.00", "description": "Cardiac failure therapy", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "8CL3.00", "description": "Heart failure care plan discussed with patient", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "8H2S.00", "description": "Admit heart failure emergency", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G232.00", "description": "Hypertensive heart&renal dis wth (congestive) heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G554000", "description": "Congestive cardiomyopathy", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G58..00", "description": "Heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580.00", "description": "Congestive heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580000", "description": "Acute congestive heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580100", "description": "Chronic congestive heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580.11", "description": "Congestive cardiac failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580.12", "description": "Right heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580200", "description": "Decompensated cardiac failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G580300", "description": "Compensated cardiac failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G581.00", "description": "Left ventricular failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G581000", "description": "Acute left ventricular failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G58..11", "description": "Cardiac failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G582.00", "description": "Acute heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G58z.00", "description": "Heart failure NOS", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G58z.11", "description": "Weak heart", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G58z.12", "description": "Cardiac failure NOS", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "SP11111", "description": "Heart failure as a complication of care", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } } ] }, { "concept_id": 2633, "concept_version_id": 6679, "concept_name": "Congestive Heart Disease - Primary Care", "coding_system": { "id": 4, "name": "ICD10 codes", "description": "ICD10 Codes" }, "phenotype_id": "PH876", "phenotype_version_id": 1831, "phenotype_name": "Congestive Heart Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "I11.0", "description": "Hypertensive heart disease wih (congestive) heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I13.0", "description": "Hypertensive heart and renal disease with (congestive) heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I13.2", "description": "Hypertensive heart and renal failure with both (congestive) heart failure and renal failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I50", "description": "Heart failure", "attributes": { "Entity type": "res69: congestive_heart_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/7ksr-av02", "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": 1831, "version_name": "Congestive Heart Disease", "version_date": "2022-04-04T07:07:55.440481Z", "is_published": true, "is_latest": true } ] } ]