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Congestive Heart Disease

Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft

Type
Disease or Syndrome
ID
PH876
Version ID
1831
Data Sources
Valid event data range
01/01/2001 - 31/12/2014
Sex
Female, Male
Agreement Date
2018-10-15
Coding system
Read codes v2 ICD10 codes
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Self-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.

Methods:

The 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.

Findings:

Overall 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.

Interpretation:

Within 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.

Publications

  • 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.

Clinical Code List

Rows: 25
Code Description Entity type Coding System (ICD-10 Read) Category
14A6.00 H/O: heart failure res69: congestive_heart_disease Read diagnostic
14AM.00 H/O: Heart failure in last year res69: congestive_heart_disease Read diagnostic
1O1..00 Heart failure confirmed res69: congestive_heart_disease Read diagnostic
662W.00 Heart failure annual review res69: congestive_heart_disease Read diagnostic
8B29.00 Cardiac failure therapy res69: congestive_heart_disease Read diagnostic
8CL3.00 Heart failure care plan discussed with patient res69: congestive_heart_disease Read diagnostic
8H2S.00 Admit heart failure emergency res69: congestive_heart_disease Read diagnostic
G232.00 Hypertensive heart&renal dis wth (congestive) heart failure res69: congestive_heart_disease Read diagnostic
G554000 Congestive cardiomyopathy res69: congestive_heart_disease Read diagnostic
G58..00 Heart failure res69: congestive_heart_disease Read diagnostic
G58..11 Cardiac failure res69: congestive_heart_disease Read diagnostic
G580.00 Congestive heart failure res69: congestive_heart_disease Read diagnostic
G580.11 Congestive cardiac failure res69: congestive_heart_disease Read diagnostic
G580.12 Right heart failure res69: congestive_heart_disease Read diagnostic
G580000 Acute congestive heart failure res69: congestive_heart_disease Read diagnostic
G580100 Chronic congestive heart failure res69: congestive_heart_disease Read diagnostic
G580200 Decompensated cardiac failure res69: congestive_heart_disease Read diagnostic
G580300 Compensated cardiac failure res69: congestive_heart_disease Read diagnostic
G581.00 Left ventricular failure res69: congestive_heart_disease Read diagnostic
G581000 Acute left ventricular failure res69: congestive_heart_disease Read diagnostic
G582.00 Acute heart failure res69: congestive_heart_disease Read diagnostic
G58z.00 Heart failure NOS res69: congestive_heart_disease Read diagnostic
G58z.11 Weak heart res69: congestive_heart_disease Read diagnostic
G58z.12 Cardiac failure NOS res69: congestive_heart_disease Read diagnostic
SP11111 Heart failure as a complication of care res69: congestive_heart_disease Read diagnostic
Rows: 4
Code Description Entity type Coding System (ICD-10 Read) Category
I11.0 Hypertensive heart disease wih (congestive) heart failure res69: congestive_heart_disease ICD-10 diagnostic
I13.0 Hypertensive heart and renal disease with (congestive) heart failure res69: congestive_heart_disease ICD-10 diagnostic
I13.2 Hypertensive heart and renal failure with both (congestive) heart failure and renal failure res69: congestive_heart_disease ICD-10 diagnostic
I50 Heart failure res69: congestive_heart_disease ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH876/version/1831/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH876/version/1831/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('PH876', '1831', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH876/version/1831/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH876/version/1831/export/codes/?format=json
CSV site_root/phenotypes/PH876/version/1831/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('PH876', '1831', api_client=client)

Version History

Version
ID
Name Owner Publish date
1831 Congestive Heart Disease ieuan.scanlon 2022-04-04 currently shown

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

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