Print

Heart Failure (P5)

S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Aschroft

Type
Disease or Syndrome
ID
PH687
Version ID
1374
Data Sources
Valid event data range
Start - 01/02/2013
Sex
Female, Male
Agreement Date
2015-11-03
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Study question:

What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?

Methods:

A 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.

Study answer and limitations:

49 927 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.

What this study adds:

The 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.

Publications

  • 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.

Clinical Code List

Rows: 26
Code Description Entity type Category Coding System (Read)
G1yz100 Rheumatic left ventricular failure res25: P5_heart_failure diagnostic Read
G58..00 Heart failure res25: P5_heart_failure diagnostic Read
G58..11 Cardiac failure res25: P5_heart_failure diagnostic Read
G580.00 Congestive heart failure res25: P5_heart_failure diagnostic Read
G580.11 Congestive cardiac failure res25: P5_heart_failure diagnostic Read
G580.12 Right heart failure res25: P5_heart_failure diagnostic Read
G580.13 Right ventricular failure res25: P5_heart_failure diagnostic Read
G580.14 Biventricular failure res25: P5_heart_failure diagnostic Read
G580000 Acute congestive heart failure res25: P5_heart_failure diagnostic Read
G580100 Chronic congestive heart failure res25: P5_heart_failure diagnostic Read
G580200 Decompensated cardiac failure res25: P5_heart_failure diagnostic Read
G580300 Compensated cardiac failure res25: P5_heart_failure diagnostic Read
G580400 Congestive heart failure due to valvular disease res25: P5_heart_failure diagnostic Read
G581.00 Left ventricular failure res25: P5_heart_failure diagnostic Read
G581.11 Asthma - cardiac res25: P5_heart_failure diagnostic Read
G581.12 Pulmonary oedema - acute res25: P5_heart_failure diagnostic Read
G581.13 Impaired left ventricular function res25: P5_heart_failure diagnostic Read
G581000 Acute left ventricular failure res25: P5_heart_failure diagnostic Read
G582.00 Acute heart failure res25: P5_heart_failure diagnostic Read
G583.00 Heart failure with normal ejection fraction res25: P5_heart_failure diagnostic Read
G583.11 HFNEF - heart failure with normal ejection fraction res25: P5_heart_failure diagnostic Read
G583.12 Heart failure with preserved ejection fraction res25: P5_heart_failure diagnostic Read
G584.00 Right ventricular failure res25: P5_heart_failure diagnostic Read
G58z.00 Heart failure NOS res25: P5_heart_failure diagnostic Read
G58z.11 Weak heart res25: P5_heart_failure diagnostic Read
G58z.12 Cardiac failure NOS res25: P5_heart_failure diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH687/version/1374/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH687/version/1374/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH687', '1374', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH687/version/1374/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH687/version/1374/export/codes/?format=json
CSV site_root/phenotypes/PH687/version/1374/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH687', '1374', api_client=client)

Version History

Version
ID
Name Owner Publish date
1374 Heart Failure (P5) ieuan.scanlon 2021-10-06 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

Print - Print page.