Abstract Details

Title Pain Treatment Strategy and Readmission Rates for Medicare Beneficiaries Post-acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-008

Objective We aim to analyze differences in hospital readmissions, a quality metric, for older adults initiating gabapentin in contrast to other medicines for post-stroke pain.

Background Acute ischemic stroke (AIS) is highly prevalent among older adults and commonly results in pain. Primary care providers generally manage follow-up care, although ideal pain management strategies remain unclear. Treatment options include gabapentinoids, tricyclic antidepressants, and various antiseizure medications.

Design/Methods In this matched cohort study, we analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for AIS between December 31, 2016, and December 31, 2021, who were discharged home. Individuals met insurance coverage criteria and did not take recommended pharmacological treatments for neuropathic pain (gabapentin, pregabalin, amitriptyline, lamotrigine, carbamazepine, and phenytoin) before hospitalization. Individuals who initiated gabapentin within 90 days of discharge (N = 1,546) were matched on days from discharge to medication initiation to individuals who initiated medications other than gabapentin (N = 285). We investigated the time to readmissions using a semi-competing risks framework.

Results The matched cohort of 1,831 initiators had a median age of 76 (IQR 11) and was 57.2% female and 81.3% Non-Hispanic White. The cumulative risks of readmission by 180 days post-initiation were 9.77% for gabapentin and 12.98% for other pain medications; risks for mortality were 9.97% and 12.63%, respectively. The average hazard ratio of readmissions, given that death had not occurred, was 0.871 (95% CI: 0.517, 1.466).

Conclusions

We found no significant difference in hospital readmission rates between gabapentin and other post-stroke pain treatment strategies. Our findings contribute to the pharmacovigilance of gabapentin in real-world Medicare beneficiaries post-AIS.

Authors/Disclosures
Madhav Sankaranarayanan PRESENTER	Mr. Sankaranarayanan has nothing to disclose.
Rebeka Bustamante Rocha, Other	Mrs. Bustamante Rocha has nothing to disclose.
Julianne Brooks	Julianne Brooks 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.
Mamoon Habib	Mamoon Habib has nothing to disclose.
Sonia Hernandez Diaz, MD, PhD	Dr. Hernandez Diaz has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche, Vertex and Biogen. Dr. Hernandez Diaz has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Journal of Epidemiology. The institution of Dr. Hernandez Diaz has received research support from Takeda, GSK and UCB.
I-Ching Tsai, MHA	Mrs. Tsai has received personal compensation for serving as an employee of Johnson&Johnson. Mrs. Tsai has stock in Johnson & Johnson.
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.
Sebastien Haneuse (Harvard T.H. Chan School of Public Health)	Sebastien Haneuse has received personal compensation for serving as an employee of Harvard University. Sebastien Haneuse has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association.
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 .

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