Table 2.
Overview of the frequency and subsequent acceptance of generated STOPP/START signals
| Signal | Definition | Frequency, n | Acceptance, % | |||
|---|---|---|---|---|---|---|
| Top ten most frequently generated STOPP signals | ||||||
| STOPP A1 | Any drug prescribed without an evidence-based clinical indication | 1412 | 54.2 | |||
| STOPP A3 | Any duplicate drug class prescription e.g. two concurrent NSAIDs, SSRIs, loop diuretics, ACEI, anticoagulants | 503 | 26.0 | |||
| STOPP D5 | Benzodiazepines for ≥4 weeks | 181 | 64.1 | |||
| STOPP F2 | PPI for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for >8 weeks | 146 | 34.9 | |||
| STOPP B6 | Loop diuretic as first-line treatment for hypertension | 101 | 22.8 | |||
| STOPP C3 | Aspirin, clopidogrel, dipyridamole, VKA, direct thrombin inhibitors or factor Xa inhibitors with concurrent significant bleeding risk, i.e. uncontrolled severe hypertension, bleeding diathesis, recent non-trivial spontaneous bleeding | 75 | 4.0 | |||
| STOPP F3 | Drugs likely to cause constipation in patients with chronic constipation where non-constipating alternatives are available | 75 | 20.0 | |||
| STOPP G2 | Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in moderate-severe COPD | 63 | 6.3 | |||
| STOPP C5 | Aspirin in combination with VKA, direct thrombin inhibitor or factor Xa inhibitors in patients with chronic AF | 60 | 31.7 | |||
| STOPP L2 | Use of regular (as distinct from PRN) opioids without concomitant laxative | 56 | 12.5 | |||
| Other STOPP criteria | 793 | 32.2 | ||||
| STOPP signals that were never generated | ||||||
| STOPP C7 | Ticlopidine in any circumstances | 0 | NA | |||
| STOPP D3 | Neuroleptics with moderate-marked antimuscarinic/anticholinergic effects with a history of prostatism or previous urinary retention | 0 | NA | |||
| STOPP D6 | Antipsychotics (i.e. other than quetiapine or clozapine) in those with parkinsonism or Lewy body disease | 0 | NA | |||
| STOPP D7 | Anticholinergics/antimuscarinics to treat extrapyramidal side effects of neuroleptic medications | 0 | NA | |||
| STOPP E5 | Colchicine if eGFR <10 ml/min/1.73 m2 | 0 | NA | |||
| STOPP F1 | Prochlorperazine or metoclopramide with Parkinsonism | 0 | NA | |||
| STOPP G1 | Theophylline as monotherapy for COPD | 0 | NA | |||
| STOPP H1 | NSAID other than COX-2 selective agents with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent PPI or H2 antagonist | 0 | NA | |||
| STOPP J2 | Thiazolidinediones in patients with heart failure | 0 | NA | |||
| STOPP J4 | Oestrogens with a history of breast cancer or venous thromboembolism | 0 | NA | |||
| STOPP M1 | Concomitant use of two or more drugs with antimuscarinic/anticholinergic properties | 0 | NA | |||
| Total | 3465 | 40.1 | ||||
| Top ten most frequently generated START signals | ||||||
| START H1 | High-potency opioids in moderate-severe pain, where paracetamol, NSAIDs, or low-potency opioids are not appropriate to the pain severity or have been ineffective | 162 | 2.5 | |||
| START A6 | ACEI with systolic heart failure and/or documented coronary artery disease | 133 | 51.1 | |||
| START E4 | Bone anti-resorptive or anabolic therapy in patients with documented osteoporosis, where no pharmacological or clinical status contraindication exists and/or previous history of fragility fracture(s) | 118 | 43.2 | |||
| START H2 | Laxatives in patients receiving opioids regularly | 115 | 47.8 | |||
| START E3 | Vitamin D and calcium supplement in patients with known osteoporosis and/or previous fragility fracture(s) and/or bone mineral density T-scores more than − 2.5 in multiple sites | 110 | 60.9 | |||
| START E5 | Vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia | 99 | 75.8 | |||
| START A5 | Statin therapy with a documented history of coronary, cerebral, or peripheral vascular disease, unless the patient’s status is end of life or age is >85 years | 80 | 62.5 | |||
| START G2 | 5α reductase inhibitor with symptomatic prostatism, where prostatectomy is not considered necessary | 79 | 15.2 | |||
| START D2 | Fibre supplements for diverticulosis with a history of constipation | 76 | 18.4 | |||
| START A1A2 | VKA or direct thrombin inhibitors or factor Xa inhibitors in the presence of chronic AF. If an oral anticoagulant is contraindicated, start aspirin (75–160 mg) instead | 72 | 50.0 | |||
| Other START criteria | 571 | 29.4 | ||||
| START signals that were never generated | ||||||
| START C4 | Topical prostaglandin, prostamides, or β-blocker for primary open-angle glaucoma | 0 | NA | |||
| START G3 | Topical vaginal oestrogen or vaginal oestrogen pessary for symptomatic atrophic vaginitis | 0 | NA | |||
| Total | 1615 | 37.2 | ||||
The ten most frequently generated signals and their subsequent acceptance as well as signals that were never generated are specified. Detailed information on frequency and acceptance for all STOPP/START signals—in total and per country—can be found in the electronic supplementary material SI1. Some of the original STOPP/START criteria v2 titles are shortened
ACEI angiotensin-converting enzyme inhibitor, AF atrial fibrillation, COPD chronic obstructive pulmonary disease, COX cyclooxygenase, eGFR estimated glomerular filtration rate, NA not applicable, NSAID non-steroidal anti-inflammatory drug, PPI proton pump inhibitor, PRN pro re nata (as needed), SSRI selective serotonin-reuptake inhibitors, START screening tool to alert to right treatment, STOPP screening tool of older persons’ prescriptions, VKA vitamin K antagonist