Review of codelists used to define hypertension in electronic health records and development of a codelist for research

Background and aimsHypertension is a leading risk factor for cardiovascular disease. Electronic health records (EHRs) are routinely collected throughout a person’s care, recording all aspects of health status, including current and past conditions, prescriptions and test results. EHRs can be used fo...

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Published in:	Open heart Vol. 11; no. 1; p. e002640
Main Authors:	Massen, Georgie May, Stone, Philip W, Kwok, Harley H Y, Jenkins, Gisli, Allen, Richard J, Wain, Louise V, Stewart, Iain, Quint, Jennifer Kathleen, Thorley, Andrew, Duckworth, Anna, Mohammadi-Nejad, Ali-Reza, Aravinthan, Aloysious, Harbottle, Anthony, Villalon, Armando Mendez, Scotton, Chris, Denton, Christopher, Lea, Daniel, Auer, Dorothee, Joof, Ebrima, Cox, Eleanor, Eves, Elizabeth, Robertson, Elizabeth, Blamont, Emma, Khan, Fasihul, Parcesepe, Gina, Moran, Gordon W., Aithal, Guruprasad P., Longhurst, Hilary, Paxton, Jane, Hanley, Karen Piper, Frost, Kate, Casmino, Leo, Chakrabarti, Lisa, Roeth, Margot, Kaisar, Maria, Craig, Martin, Nation, Michael, Kisomi, Mohammad Alireza, Zeybel, Mujdat
Format:	Journal Article
Language:	English
Published:	England British Cardiovascular Society 15-04-2024 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Algorithms Blood pressure Cardiac risk factors and prevention Cardiovascular disease Codes Electronic Health Records Epidemiology Health services Humans Hypertension Hypertension - diagnosis Hypertension - therapy International Classification of Diseases Observational studies Primary care Reproducibility Reproducibility of Results Systematized Nomenclature of Medicine United Kingdom > UK United States > US Hypertension Electronic Health Records Epidemiology
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Summary:	Background and aimsHypertension is a leading risk factor for cardiovascular disease. Electronic health records (EHRs) are routinely collected throughout a person’s care, recording all aspects of health status, including current and past conditions, prescriptions and test results. EHRs can be used for epidemiological research. However, there are nuances in the way conditions are recorded using clinical coding; it is important to understand the methods which have been applied to define exposures, covariates and outcomes to enable interpretation of study findings. This study aimed to identify codelists used to define hypertension in studies that use EHRs and generate recommended codelists to support reproducibility and consistency.Eligibility criteriaStudies included populations with hypertension defined within an EHR between January 2010 and August 2023 and were systematically identified using MEDLINE and Embase. A summary of the most frequently used sources and codes is described. Due to an absence of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codelists in the literature, a recommended SNOMED CT codelist was developed to aid consistency and standardisation of hypertension research using EHRs.Findings375 manuscripts met the study criteria and were eligible for inclusion, and 112 (29.9%) reported codelists. The International Classification of Diseases (ICD) was the most frequently used clinical terminology, 59 manuscripts provided ICD 9 codelists (53%) and 58 included ICD 10 codelists (52%). Informed by commonly used ICD and Read codes, usage recommendations were made. We derived SNOMED CT codelists informed by National Institute for Health and Care Excellence guidelines for hypertension management. It is recommended that these codelists be used to identify hypertension in EHRs using SNOMED CT codes.ConclusionsLess than one-third of hypertension studies using EHRs included their codelists. Transparent methodology for codelist creation is essential for replication and will aid interpretation of study findings. We created SNOMED CT codelists to support and standardise hypertension definitions in EHR studies.
Bibliography:	Systematic review ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2053-3624 2398-595X 2053-3624
DOI:	10.1136/openhrt-2024-002640