Table 4

Potentially Inappropriate medication at admission and at discharge identified by START criteria classified by physiological system

PIM, n(%)
AdmissionDischarge
A. Cardiovascular system27 (28.1%)21 (24.4%)
 Warfarin in the presence of chronic atrial fibrillation42
 Aspirin in the presence of chronic atrial fibrillation, where warfarin is contraindicated, but not aspirin02
 Aspirin or clopidogrel with a documented history of atherosclerotic coronary, cerebral or peripheral vascular disease in patients with sinus rhythm74
 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 years21
 ACE inhibitor with chronic heart failure97
 ACE inhibitor following acute myocardial infarction55
B. Respiratory system1 (1.0%)1 (1.2%)
 Regular inhaled corticosteroid for moderate/severe asthma or COPD, where predicted FEV1<50%11
E. Musculoskeletal system14 (14.6%)11 (12.8%)
 Disease-modifying antirheumatic drug (DMARD) with active moderate/severe rheumatoid disease lasting >12 weeks01
 Bisphosphonates in patients taking maintenance corticosteroid01
 Calcium and vitamin D supplement in patients with known osteoporosis (previous fragility fracture, acquired dorsal kyphosis)149
F. Endocrine system54 (56.3%)53 (61.6%)
 Metformin with type 2 diabetes ± metabolic syndrome (in the absence of renal impairment)1111
 ACE inhibitor or angiotensin receptor blocker in diabetes with nephropathy—ie, overt urinalysis proteinuria or microalbuminuria (>30 mg/24 hours) ± serum biochemical renal impairment43
 Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors (hypertension, hypercholesterolaemia, smoking history)1414
 Statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present2525
  • ACE, angiotensin-converting enzyme; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in one second; PIM. potentially inappropriate medications.