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Objective: We examined the impact of receiving benzodiazepines (BZDs) within 30 days post-discharge on survival among Medicare beneficiaries after an acute ischemic stroke (AIS). Background: 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. Design/Methods: 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. Results: 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. Conclusions: 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.