2022 Changes to the Universal Definition and Classification of Heart Failure - Impact on SNOMED CT

24 Jan 2022

Response on attached briefing note 

@Elaine Wooler

Please post your final responses in the Country response table below. Discussion comments can be made as comments.

USA

23JAN2022

I am afraid there is not a good solution to this problem. Essentially, the current concept is for "A or B". We can retire it and create "A" and "B", which will be disruptive for analytics – 2 queries needed for before and after the change. Or we can transform "A or B" into "A alone" and  create B, which seems less disruptive, but will muddy the analytical waters. The continuation of "A or B" into "A alone" will result in queries for this concept that return different cohorts depending on when the query was made ("A or B" before the change, "A alone" after).

Regardless of the solution, it looks like such changes require careful documentation and education.

Also, this type of change is not uncommon – it has been seen many times in the UMLS Metathesaurus. Such changes should be handled uniformly, not on a case-by-case basis. From an editorial perspective, SNOMED International should have a policy about such changes and how to handle them.

Norway

01.02.2022

We prefer option 1, if this entails the creation of the 4 concepts. It is very important that the resulting hierarchy under Heart failure is consistent.

UK

09.02.2022

This has been discussed and feedback will be provided by Emma via Member Forum.

The Netherlands

9-2-2022

We prefer option 2, it's the most consistent solution and in line with the authoring guides.

Australia

20220221

Our preference is Option 2. We do note that either option will have significant work in Terminology especially with regards to modelling as these changes will also have an impact on its descendants. We also note that the affected concepts appear in several of our reference sets.

Will there be a remodeling of the attribute |Finding site - Left cardiac ventricular structure| once the synonym |Left ventricular failure| is inactivated? We also note that the terms 364006 |Acute left-sided heart failure (disorder)| and 111283005 |Chronic left-sided heart failure (disorder)| have the |Finding site - Left cardiac ventricular structure|.

With the creation of new concepts |Left heart failure| and |Right heart failure|, are you looking at modelling it with Finding site - 17398003 |Structure of left side of heart| and 79561009 |Structure of right side of heart|, respectively?

Member countries without a CMAG rep