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Palliative and end of life care

Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland

Type
Disease or Syndrome
ID
PH869
Version ID
1817
Data Sources
Valid event data range
01/01/2005 - 30/11/2018
Sex
Female, Male
Agreement Date
2022-02-02
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Studies 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.

Methods:

This 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.

Results:

The 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.

Conclusions:

Mortality 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.

Publications

  • 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.

Clinical Code List

Rows: 54
Code Description Entity type Category Coding System (Read)
66S3.00 full care by hospice res176: Palliative and end of life care diagnostic Read
66S4.00 shared care - hospice / gp res176: Palliative and end of life care diagnostic Read
8B2a.00 prescription of palliative care anticipatory medication res176: Palliative and end of life care diagnostic Read
8BA2.11 end of life care res176: Palliative and end of life care diagnostic Read
8BAN.00 community specialist palliative care res176: Palliative and end of life care diagnostic Read
8BAP.00 specialist palliative care res176: Palliative and end of life care diagnostic Read
8BAQ.00 final days pathway res176: Palliative and end of life care diagnostic Read
8BAR.00 specialist palliative care treatment - inpatient res176: Palliative and end of life care diagnostic Read
8BAS.00 specialist palliative care treatment - daycare res176: Palliative and end of life care diagnostic Read
8BAT.00 specialist palliative care treatment - outpatient res176: Palliative and end of life care diagnostic Read
8BAe.00 anticipatory palliative care res176: Palliative and end of life care diagnostic Read
8BJ1.00 palliative treatment res176: Palliative and end of life care diagnostic Read
8BMM.00 issue of palliative care anticipatory medication box res176: Palliative and end of life care diagnostic Read
8BMM.11 issue of palliative care just in case box res176: Palliative and end of life care diagnostic Read
8CM1.00 on gold standards palliative care framework res176: Palliative and end of life care diagnostic Read
8CMW300 end of life care pathway res176: Palliative and end of life care diagnostic Read
8H7g.00 referral to palliative care service res176: Palliative and end of life care diagnostic Read
8HH7.00 referred to community specialist palliative care team res176: Palliative and end of life care diagnostic Read
8HX..00 admission to hospice res176: Palliative and end of life care diagnostic Read
8HX0.00 urgent admission to hospice res176: Palliative and end of life care diagnostic Read
8HX1.00 routine admission to hospice res176: Palliative and end of life care diagnostic Read
8HX2.00 admission to hospice for respite res176: Palliative and end of life care diagnostic Read
8HY..00 referral to hospice res176: Palliative and end of life care diagnostic Read
8Hg0.00 discharged from community specialist palliative care team res176: Palliative and end of life care diagnostic Read
8HgX.00 discharge from palliative care service res176: Palliative and end of life care diagnostic Read
8Hga.00 discharge from hospice res176: Palliative and end of life care diagnostic Read
949A.00 patient died in hospice res176: Palliative and end of life care diagnostic Read
949G.00 patient died in hospice community lodge res176: Palliative and end of life care diagnostic Read
9NNZ.00 has end of life care pathway key worker res176: Palliative and end of life care diagnostic Read
9NNd.00 under care of palliative care specialist nurse res176: Palliative and end of life care diagnostic Read
9NNf000 under care of palliative care physician res176: Palliative and end of life care diagnostic Read
9Ng7.00 on end of life care register res176: Palliative and end of life care diagnostic Read
9NgD.00 under care of palliative care service res176: Palliative and end of life care diagnostic Read
9Nh0.00 under the care of community palliative care team res176: Palliative and end of life care diagnostic Read
9NkJ.00 seen in hospice res176: Palliative and end of life care diagnostic Read
9NlJ.00 seen by palliative care service res176: Palliative and end of life care diagnostic Read
9b1B.00 hospice - nhs res176: Palliative and end of life care diagnostic Read
9b1C.00 hospice - independent res176: Palliative and end of life care diagnostic Read
9b74.00 hospice res176: Palliative and end of life care diagnostic Read
9b74000 hospice community lodge res176: Palliative and end of life care diagnostic Read
9b9B.00 palliative medicine res176: Palliative and end of life care diagnostic Read
9c0L000 planned palliative oncology treatment res176: Palliative and end of life care diagnostic Read
9c0P.00 current palliative oncology treatment res176: Palliative and end of life care diagnostic Read
9e02.00 notif to primary care oohs of palliative care plan in place res176: Palliative and end of life care diagnostic Read
M270300 hospice acquired pressure ulcer res176: Palliative and end of life care diagnostic Read
Z172.00 palliative care res176: Palliative and end of life care diagnostic Read
ZL18R00 under care of palliative care physician res176: Palliative and end of life care diagnostic Read
ZL5AP00 referral to palliative care physician res176: Palliative and end of life care diagnostic Read
ZL9AR00 seen by palliative care physician res176: Palliative and end of life care diagnostic Read
ZLD3R00 discharge by palliative care physician res176: Palliative and end of life care diagnostic Read
ZLE6P00 discharge from palliative care service res176: Palliative and end of life care diagnostic Read
ZLF1.00 discharge from hospice res176: Palliative and end of life care diagnostic Read
ZLF1100 discharge from hospice day hospital res176: Palliative and end of life care diagnostic Read
ZV57C00 [v]palliative care res176: Palliative and end of life care diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH869/version/1817/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH869/version/1817/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('PH869', '1817', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH869/version/1817/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH869/version/1817/export/codes/?format=json
CSV site_root/phenotypes/PH869/version/1817/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('PH869', '1817', api_client=client)

Version History

Version
ID
Name Owner Publish date
1817 Palliative and end of life care ieuan.scanlon 2022-04-04 currently shown

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