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Abstract Details

Patterns of Benzodiazepine Initiation Among Older Acute Ischemic Stroke Survivors
Practice, Policy, and Ethics
P1 - Poster Session 1 (8:00 AM-9:00 AM)
10-006
Describe temporal changes in outpatient Benzodiazepine (BDZ) initiation rates following Acute Ischemic Stroke (AIS) discharge among Medicare beneficiaries.
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.
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. 

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.
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.
Authors/Disclosures
Victor Lomachinsky Torres, MD
PRESENTER 		Dr. Lomachinsky Torres has nothing to disclose.
Julianne Brooks Julianne Brooks has nothing to disclose.
Maria Donahue (Massachusetts General Hospital) Maria Donahue has nothing to disclose.
Deborah Blacker Deborah Blacker has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Belvoir inc. The institution of Deborah Blacker has received research support from NIH.
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System) Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime 好色先生. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.
John Hsu No disclosure on file
Joseph Newhouse (Harvard University) Joseph Newhouse has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for National Committee for Quality Assurance. Joseph Newhouse has received publishing royalties from a publication relating to health care.
Lidia Maria V. Moura, MD, PhD, MPH, FAAN (Massachusetts General Hospital) Dr. Moura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Moura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. The institution of Dr. Moura has received research support from Centers for Diseases Control and Prevention (CDC SIP20-007) . The institution of Dr. Moura has received research support from Epilepsy Foundation of America . The institution of Dr. Moura has received research support from NIH - NIA and NINDS. Dr. Moura has received personal compensation in the range of $50,000-$99,999 for serving as a Expert Advisor with Epilepsy Foundation .