Jim Case

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Jim Case

None stated.

Elaine Wooler

Postponed until the April Business meeting

The Netherlands have pointed out the inconsistency with the following two concepts:

85232009 |Left heart failure (disorder)| - has synonym, Left ventricular failure.

367363000 |Right ventricular failure (disorder)| - has synonym, Right heart failure

Their cardiology experts advise left/right heart failure can be caused by ventricular or valve disease. They have suggested the following structure with three new concepts:

Left heart failure (disorder)

-Left ventricular failure (disorder)

Right heart failure (disorder)

-367363000 |Right ventricular failure (disorder)|

A position paper posted earlier this year proposing new definitions are consistent with the Netherlands cardiologist view.

https://confluence.ihtsdotools.org/pages/viewpage.action?pageId=82894146&preview=%2F82894146%2F125995123%2FUniversal+definition+and+classification+of+heart+failure.pdf

UNIVERSAL DEFINITION OF HF
HF is a clinical syndrome with current or prior

Symptoms and or signs (Table 6) caused by a structural and/or functional cardiac abnormality (as determined by EF <50%, abnormal cardiac chamber enlargement, E/E′ >15, moderate/severe ventricular hypertrophy or moderate/severe valvular obstructive or regurgitant lesion)
and corroborated by at least one of the following:
Elevated natriuretic peptide levels (for values refer to Table 7)
Objective evidence of cardiogenic pulmonary or systemic congestion by diagnostic modalities such as imaging (e.g. by chest X-ray or elevated filling pressures by echocardiography) or haemodynamic measurement (e.g. right heart catheterization, pulmonary artery catheter) at rest or with provocation (e.g. exercise).

A briefing note has been prepared to address potential changes (see PDF in meeting files).

We have received comments from the CMAG.  The US Comments expose the complexity of the issue:(Changes to the Universal Definition and Classification of Heart Failure - Impact on SNOMED CT)

Discussion:

Discussion:

A question from a member country on when to use "X (person)" vs. "X of subject (person)" has exposed issues with determination of equivalence in information models that either split the relationship from the condition vs. using a precoordinated Situation concept to represent the SUBJECT RELATIONSHIP CONTEXT.

Discussion:

"X of person" was introduced to support the SUBJECT_RELATIONSHIP_CONTEXT of Situations.  Monique van Berkumwill look for some history on why they were added. Suggested that the ECE might have some history on these.  Question is whether we need to separate out the relationship values from "persons" as a class?

Background - https://confluence.ihtsdotools.org/download/attachments/17039782/Subject%20relationship%20context%20values_EDC_20060127.doc?api=v2

The main distinction made in the reference paper is that between an "Entity" and the "Role" played by an Entity.  However, this distinction is not made within the person hierarchy, with << 444148008 |Person in family of subject (person)| primarily representing roles that Person entities play being in the same Person hierarchy. Since the 444148008 |Person in family of subject (person)| is primarily used as values for the SUBJECT RELATIONSHIP CONTEXT attribute, we can question why it is in the Person entity hierarchy.

A question raised by the reference provided is whether a well-established role (e.g. father) can also exist as an entity?  Can a father exist as a standalone entity without the establishment of a relationship to another entity?

Decision:

Background will be investigated.  The person hierarchy needs some review and rationalization.

Background document posted above.  Will review for next meeting. Make sure page is open for viewing by the EAG.  

• Monique van Berkumto investigate history of "X of person" concepts.

Discussion: