Bastiaan Sallevelt

119 Conversion of STOPP/START version 2 into coded algorithms Table 2. Implications of applying the coding principles to the criteria. Coding principle Examplesa Solution based on ICD-10 coding 1 STOPP D1 ‘TCAs with dementia, narrow angle glaucoma, cardiac conduction abnormalities…’ STOPP B11 ‘ACE inhibitors or Angiotensin Receptor Blockers in patients with hyperkalemia’ START A1: ‘Vitamin K antagonist…presence of chronic atrial fibrillation’ Not specified: Both I44 ‘Atrioventricular and left bundle-branch block’ and I45: ‘Other conduction disorders’ including all sub categories are included. No cut-off value specified. We decided to define ≥5.0 mmol/L as hyperkalemia in all criteria addressing this condition without mentioned cut-off values (i.e. STOPP B12) Exact match in ICD-10 I48.2 ‘Chronic atrial fibrillation’ exists and preferred over I48: ‘atrial fibrillation and flutter’ 2 STOPP B8 ‘Thiazide diuretic with current significant hypokalemia (i.e. serum K+ < 3.0 mmol/l), hyponatremia (i.e. serum Na+ < 130 mmol/l) hypercalcemia (i.e. corrected serum calcium > 2.65 mmol/l)…’ Laboratory values coded as LOINC term with cut-off levels. Priority in the algorithm is given to LOINC codes over ICD10 diagnosis E87.5 ‘hyperkalemia’ 3 START A3 ‘Antiplatelet therapy (aspirin or clopidogrel or prasugrel or ticagrelor)…’ STOPP C6 ‘Antiplatelet therapy with vitamin K antagonist…’ Specification of individual drugs: only these four were included in the algorithm. All antiplatelet agents registered under ATC B01AC* were included 4 START A6 ‘Angiotensin Converting Enzyme (ACE) inhibitor with a systolic heart failure and/or documented coronary artery disease’ Included ICD-10 codes according to expert consensus: I20 Angina pectoris I21 Acute myocardial infarction I22 Subsequent myocardial infarction I24 Other acute ischemic heart diseases I25 Chronic ischemic heart disease Z95.1 Presence of aortocoronary bypass graft and Z95.5 Presence of coronary angioplasty implant and graft 2