Introduction Drug-related problems (DRPs) are common in elderly patients, the majority being preventable. Several criteria have been published to help clinicians identify DRPs due to inappropriate prescribing. However, few studies provide criteria to help clinicians identify underuse of medication considered beneficial. This study aimed to quantify and characterise prescribing omissions of cardiovascular risk management therapy using START (Screening Tool to Alert Doctors to the Right Treatment) criteria.

Methods A descriptive study was conducted in the Stroke Unity of Hospital Center of Cova da Beira. During 3 months the medical files of all elderly patients (age ≥65 years) admitted with acute cardiovascular disease were reviewed and START criteria applied to the information of medication, at admission and clinic discharge.

Results During the study period 56 elderly patients were admitted to the Stroke Unit. At the time of admission 63 prescribing omissions were found in 69.8% of elderly (average 1.19 omissions per patient), of which 74.5% (n=38) were corrected at the time of discharge. Prescribing omissions were also detected in 80.9% of patients receiving five or more medications simultaneously. In 10 patients, 13 omissions found at admission were not corrected during hospitalisation, and in three patients three new omissions were detected.

Conclusion The prevalence of prescribing omissions of cardiovascular risk management therapy in elderly patients admitted to a Stroke Unity is high. START criteria is an evidence-based and easy-to-use screening tool that can assist clinicians in the optimisation of geriatric therapy, particularly in relation to cardiovascular disease prevention.