78 CHAPTER 2.2 SUPPLEMENTARY INFORMATION SI1 Clarity ratings per element for 80 STOPP and 34 START recommendations Table SI1.1. Clarity rating for STOPP criteria. STOPP Action Clarity rating Condition Clarity rating Explanation Clarity rating A A1 Any drug 100% prescribed without an evidence-based clinical indication. 8% N/A A2 Any drug 100% prescribed beyond the recommended duration, where treatment duration is well defined 8% N/A A3 Any duplicate drug class prescription e.g. two concurrent NSAIDs, SSRIs, loop diuretics, ACE inhibitors, anticoagulants 33% [users with...duplicate drug class prescription] 17% (optimisation of monotherapy within a single drug class should be observed prior to considering a new agent). 33% B B1 Digoxin 100% for heart failure with normal systolic ventricular function 58% (no clear evidence of benefit). 58% B2 Verapamil or diltiazem 100% with NYHA Class III or IV heart failure 58% (may worsen heart failure). 75% B3 Beta-blocker 67% in combination with verapamil or diltiazem 92% (risk of heart block). 75% B4 Beta blocker 67% with bradycardia (< 50/ min) , type II heart block or complete heart block 42% (risk of profound hypotension, asystole). 75%
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