Antiseizure Medication Prescriptions for Medicare Beneficiaries Following Acute Ischemic Stroke
Abstract number :
3.286
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2023
Submission ID :
857
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
First Author: Yashmi Shirish Sevak, MS – Massachusetts General Hospital
Presenting Author: Maria Donahue, MD – Massachusetts General Hospital
Lilian Maria Godeiro Coelho, MD – Massachusetts General Hospital; Deborah Blacker, MD, ScD – Massachusetts General Hospital, Harvard T.H. Chan School of Public Health, Harvard Medical School; Maria Donahue, M.D. – Massachusetts General Hospital; Sebastien Haneuse, PhD – Harvard T.H. Chan School of Public Health; John Hsu, MD, MBA, MSCE – Harvard Medical School, Massachusetts General Hospital; Lidia M.V. Moura, MD, PhD, MPH – Harvard Medical School, Massachusetts General Hospital; Joseph Newhouse, PhD – Harvard Medical School, National Bureau of Economic Research, Harvard T.H. Chan School of Public Health, Harvard Kennedy School; Lee Schwamm, M.D. – Yale New Haven Health
Rationale:
Despite safety concerns, antiseizure medications (ASMs) are frequently prescribed following an acute ischemic stroke (AIS). They are used for various purposes, such as seizure prophylaxis, pain management, and anxiety reduction. However, the impact of ASMs on outcomes for older adults is a significant concern. This study described ASM outpatient initiation patterns among older adult Medicare beneficiaries post-AIS.
Methods:
We conducted a retrospective analysis using the National Medicare Claims Data from January 1st, 2011 to December 31st, 2019. We included Medicare Beneficiaries ≥65 years enrolled in Parts A, B, and D, with a confirmed new AIS hospitalization (ICD-9 or ICD-10 codes) and no recorded use of ASMs in the three months before admission, being discharged alive to home/self- care. The descriptive analysis included demographics, Charlson Comorbidity Score (CCS) 12 months before the admission, the proportion of patients who filled (received) any ASM (including Benzodiazepines, Gabapentin, and other ASMs) within 90 days after discharge, and the time window of the first part D medication event (0-30, 31-60, 61-90 days) for all the ASM groups.
Results:
The study included a sample of 76,545 eligible beneficiaries with a mean age of 78 years ± 8.3. Among the beneficiaries, 57.4% were female, and 79.1% identified as white. Within 90 days post-discharge, 24.9% (n=19,046) of the patients received at least one antiseizure medication (ASM); 10.6% (n=8,091) of the initiators received benzodiazepines, 11.4% (n=8,726) received gabapentin, and 6.9% (n=5,257) received other ASMs (Table 1). Among those patients, 42.5% (n=12,022) received ASM prescriptions within 0-30 days of discharge, 14.7% (n=4,144) within 31-60 days, and 10.2% (n=2,880) within 61-90 days. Of the beneficiaries who received more than one ASM prescription within 90 days of discharge, 8.2% (n=1,565) received a prescription for benzodiazepine and gabapentin, 4.3% (n=828) for benzodiazepines and other ASMs, and 4.3% (n= 830) for gabapentin and other ASMs (Table 1). The number of first prescriptions of medications groups on the day of discharge for All ASMs, Benzodiazepine, Gabapentin, and other ASMs are 12.5% (n= 2,390), 3% (n= 583), 4% (n= 754), and 6.6% (n= 1,266) respectively (Figure 1).
Conclusions:
Our nationwide analysis revealed that ASMs were prescribed frequently to older patients within 90 days post-AIS discharge. A notable proportion of these patients were prescribed benzodiazepines, despite recommendations for cautious use in this age group.
Funding:
NIH1R01AG073410-01
Anti-seizure Medications