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Abstract Details

Benzodiazepine Initiation Effect on Mortality Among Medicare Beneficiaries Post Acute Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
P7 - Poster Session 7 (5:00 PM-6:00 PM)
14-009
We examined the impact of receiving benzodiazepines (BZDs) within 30 days post-discharge on survival among Medicare beneficiaries after an acute ischemic stroke (AIS).
BZDs are prescribed to older AIS survivors for agitation, insomnia, and anxiety, despite guideline warnings due to adverse effects. More studies are needed on outcomes in the sub-acute AIS recover period for the older population.
We analyzed a sample of eligible Medicare beneficiaries enrolled for at least 12 months before admission using inpatient data. We excluded those prescribed BZDs within 90 days before hospitalization, died during their hospital stay, left against medical advice, or were discharged to institutional post-acute care. Our primary exposure was BZD initiation within 30 days post-discharge, and its primary outcome on 90-day mortality risk differences (RDs) from discharge using trial emulation methods (i.e., cloning, weighting, censoring, and inverse-probability-of-censoring weighting) to address confounding.
Of 47,421 beneficiaries, 826 (1.74%) initiated BZD within 30 days post-discharge, and 6,392 (13.48%) died within 90 days. The median age was 79 (inter-quartile range 73-85), demographically 55.3% female, 82.9% White, 10.1% Black, 1.7% Hispanic, and  2.2% Asian, and 0.4% American Native. After standardization (based on age, sex, race/ethnicity, length of stay, and baseline dementia), the 90-day mortality risk revealed a RD of 26 events per 1,000 (95% CI: 22, 33). Subgroup analyses revealed higher RDs in older age groups, particularly those aged 86 or older, with an RD of 84 events per 1,000 (95% CI: 73, 106). Patients with baseline dementia had an RD of 87 events per 1,000 (95% CI: 63, 112), compared to 18 events per 1,000 (95% CI: 13, 21) for those without.
Initiating BZDs within 30 days post-AIS discharge significantly increased the 90-day mortality risk, especially in adults 76 years or older and those with baseline dementia, highlighting their vulnerability to BZD adverse effects.
Authors/Disclosures
Madhav Sankaranarayanan
PRESENTER 		Mr. Sankaranarayanan has nothing to disclose.
Maria Donahue (Massachusetts General Hospital) Maria Donahue has nothing to disclose.
Shuo M. Sun, PhD (Harvard T.H. Chan School of Public Health) Dr. Sun has nothing to disclose.
Julianne Brooks Julianne Brooks has nothing to disclose.
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.
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.
John Hsu No disclosure on file
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.
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 .