Potentially Inappropriate medication at admission and at discharge identified by START criteria classified by physiological system
| PIM, n(%) | ||
| Admission | Discharge | |
| A. Cardiovascular system | 27 (28.1%) | 21 (24.4%) |
| Warfarin in the presence of chronic atrial fibrillation | 4 | 2 |
| Aspirin in the presence of chronic atrial fibrillation, where warfarin is contraindicated, but not aspirin | 0 | 2 |
| Aspirin or clopidogrel with a documented history of atherosclerotic coronary, cerebral or peripheral vascular disease in patients with sinus rhythm | 7 | 4 |
| Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease, where the patient’s functional status remains independent for activities of daily living and life expectancy is >5 years | 2 | 1 |
| ACE inhibitor with chronic heart failure | 9 | 7 |
| ACE inhibitor following acute myocardial infarction | 5 | 5 |
| B. Respiratory system | 1 (1.0%) | 1 (1.2%) |
| Regular inhaled corticosteroid for moderate/severe asthma or COPD, where predicted FEV1<50% | 1 | 1 |
| E. Musculoskeletal system | 14 (14.6%) | 11 (12.8%) |
| Disease-modifying antirheumatic drug (DMARD) with active moderate/severe rheumatoid disease lasting >12 weeks | 0 | 1 |
| Bisphosphonates in patients taking maintenance corticosteroid | 0 | 1 |
| Calcium and vitamin D supplement in patients with known osteoporosis (previous fragility fracture, acquired dorsal kyphosis) | 14 | 9 |
| F. Endocrine system | 54 (56.3%) | 53 (61.6%) |
| Metformin with type 2 diabetes ± metabolic syndrome (in the absence of renal impairment) | 11 | 11 |
| ACE inhibitor or angiotensin receptor blocker in diabetes with nephropathy—ie, overt urinalysis proteinuria or microalbuminuria (>30 mg/24 hours) ± serum biochemical renal impairment | 4 | 3 |
| Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors (hypertension, hypercholesterolaemia, smoking history) | 14 | 14 |
| Statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present | 25 | 25 |
ACE, angiotensin-converting enzyme; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in one second; PIM. potentially inappropriate medications.