Patterns of Benzodiazepine Initiation Among Older Acute Ischemic Stroke Survivors
Victor Lomachinsky Torres1, Julianne D. Brooks1, Maria A. Donahue1, Deborah Blacker2, Lee Schwamm3, John Hsu4, Joseph P. Newhouse4, Lidia M.V.R. Moura1
1Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 2Department of Epidemiology, Harvard T.H. Chan School of Public Health, 3Yale New Haven Health System, 4Department of Health Care Policy, Harvard Medical School
Objective:
Describe temporal changes in outpatient Benzodiazepine (BDZ) initiation rates following Acute Ischemic Stroke (AIS) discharge among Medicare beneficiaries.
Background:
Despite recommendations suggesting avoidance of BDZs in older individuals, prescriptions are still prevalent. Brain damage from acute ischemic stroke increases susceptibility to BDZs, especially in older individuals. There is however limited population level data on this issue.
Design/Methods:
Using a random 20% sample of National Medicare Claims (2013-2019), we sampled discharges of patients aged 65 years or older with at least six months of prior enrollment to parts A, B and D. We excluded beneficiaries who had BDZ prescriptions within 120 days before admission, died while inpatient, were discharged against medical advice, or were discharged to skilled nursing facilities. We examined characteristics of both initiators and non-initiators, such as age, sex and region of residence. We assessed yearly rates of BDZ initiation within 90 days post-discharge using the Cochran-Armitage test for trends.
Results:
We analyzed a total of 162,285 records. Within 90 days following discharge, overall BDZ outpatient initiation rate was 28.9 initiators per 100 person-years (95% CI 28.4, 29.3). Mean age of initiators was 75.4 years (SD 11.3), 61.2% were female and 85% were white. Mean age in the non-initiator subset was 76.8 years (SD 10.6), 54% were female and 80% were white. The greatest initiation rate was seen in the Southeast (32.82 initiators/100 PY; 95% CI 31.8-33.85) and the lowest in the Midwest 26.65/100 PY (95% CI 25.72-27.61). From 2013 to 2019, there was an overall 90-days BDZ initiation rate decline (p<0.001) with a rate difference of 19 initiators/100 PY over the study period.
Conclusions:
Starting in 2013, we noted a yearly decline in BDZ initiation among AIS survivors. We also identified demographic and regional differences that warrant future investigation and may provide insight into underlying factors contributing to such trends.