Benzodiazepine Use in Ischemic Stroke Patients: Decline in Initiation, Yet Excess Supply Persists, Study Reveals

The researchers noted, "Although there was a gradual decrease in the initiation of benzodiazepine prescriptions from 2013 to 2021, the findings revealed an excessive supply of these medications following discharge after an acute ischemic stroke. This situation highlights the urgent need for better prescribing policies."

The findings were published online on October 17, 2024, in Stroke, the official journal of the American Heart Association (AHA).

Benzodiazepines are commonly prescribed for anxiety, insomnia, and other conditions, but they come with risks, particularly for older adults and those recovering from significant medical events like a stroke. The potential for dependency, increased risk of falls, and cognitive impairment are particularly concerning in stroke survivors, who may already face challenges related to mobility and mental health. While guidelines recommend against prescribing to individuals aged 65 and older, there is limited knowledge about national prescription patterns in this demographic.

To fill this knowledge gap, Julianne D. Brooks, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues aimed to analyze the patterns of benzodiazepine prescriptions among ischemic stroke survivors, particularly focusing on the prevalence of excessive supply following discharge and examining longitudinal trends in usage, especially in patients aged 65 and older, where guidelines recommend against such prescriptions.

For this purpose, the researchers analyzed a 20% sample of Medicare claims from April 1, 2013, to September 30, 2021. They focused on beneficiaries aged 65 and older who were discharged alive after an acute ischemic stroke and had traditional Medicare coverage, along with six months of prior enrollment in Parts A (hospital insurance), B (medical insurance), and D (drug coverage).

Individuals with prior benzodiazepine prescriptions, those who self-discharged, or those discharged to skilled nursing facilities were excluded from the study. The researchers analyzed demographics, comorbidities, the duration of initial prescription supplies, and the cumulative incidence of benzodiazepine fills within 90 days after discharge. They also analyzed geographic and yearly trends.

The study led to the following findings:

• The study included 126,050 beneficiaries with a mean age of 78 years (SD, 8), of whom 54% were female and 82% were White.
• Within 90 days post-discharge, 6,127 individuals (4.9%) started a benzodiazepine.
• Among the new prescriptions, lorazepam (40%) and alprazolam (33%) were the most commonly prescribed.
• Most initial fills (76%) were supplied of more than 7 days, with 55% offering between 15 and 30 days.
• The initiation rates were higher for females (5.5%) than males (3.8%).
• Geographically, initiation rates were highest in the Southeast (5.1%) and lowest in the Midwest (4.0%), with a modest decline in nationwide initiation rates from 2013 to 2021 (cumulative incidence difference of 1.6%).

"While the number of new prescriptions decreased over the study period, the total supply of benzodiazepines remained disproportionately high. This discrepancy suggests that many patients continue to receive these medications even when they may not be clinically justified," the researchers concluded.

Reference:

Lomachinsky Torres V, et al "Benzodiazepine utilization in ischemic stroke survivors: analyzing initial excess supply and longitudinal trends" Stroke 2024; DOI: 10.1161/STROKEAHA.124.047257.