National Patterns of Outpatient Epilepsy-specific Medication Initiation Post-acute Ischemic Stroke
Abstract number :
3.436
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2024
Submission ID :
73
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Julianne Brooks, M.P.H. – Massachusetts General Hospital
Maria Donahue, MD – Massachusetts General Hospital
Deborah Blacker, MD, ScD – Massachusetts General Hospital, Harvard T.H. Chan School of Public Health
John Hsu, MD, MBA, MSCE – Massachusetts General Hospital, Harvard Medical School
Lee Schwamm, MD – Yale New Haven Health, School of Public Health
Joseph Newhouse, PhD – Harvard Medical School, Harvard Kennedy School, National Bureau of Economic Research
Sebastien Haneuse, PhD – Harvard T.H. Chan School of Public Health
Lidia V.M.D. Moura, M.D., PhD, MPH – Massachusetts General Hospital
Rationale: Acute ischemic stroke (AIS) stands as a leading cause of hospitalization among older adults, contributing to 40-55% of new epileptic seizures within this demographic.1 FDA-approved newer epilepsy-specific medications (ESMs; e.g., levetiracetam, lamotrigine) are arguably safer for older adults. However, there is scarce data on outpatient ESM initiation trends and drug choice and concerns about inequities and biases in drug initiation strategies. We analyzed a national Medicare sample to understand outpatient ESM initiation patterns post-AIS discharge in older adults and to explore differences based on race, ethnicity, and geography.
Methods: Using the Medicare Provider Analysis and Review (MedPAR) database, Traditional Medicare (TM) claims, and Part D Prescription Drug Event data, we analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for AIS between 2013-2021. We included individuals enrolled in TM Parts A, B, and D for at least 12 months before admission. We excluded individuals who had been prescribed ESM within 120 days before hospitalization, as well as those deceased during their hospital stay, left against medical advice, or discharged to skilled nursing facilities. We categorized race/ethnicity using the Research Triangle Institute race/ethnicity variable in the Medicare dataset. We estimated the cumulative incidence of ESM initiation within 120 days post-AIS discharge, censoring person time if individuals died or experienced an inpatient re-admission. We stratified our analysis by US geographic region, year of discharge, and race/ethnicity.
Results: Of the 131,989 community-dwelling beneficiaries post-AIS discharge, 3,302 (2.5%) initiated ESM within the 90-day follow-up period. Our sample had a mean age of 79 (Range 65-110) and was 56% female, 81% Non-Hispanic White, 10% Black/African American, 5% Hispanic, and 3% Asian. The cumulative incidence of new ESM initiation at 90 days in the full sample was 1.9% (95% CI: 1.9, 2.0%), and it was 2.9% (95% CI: 2.6, 3.2%) for Black/African American, 2.8% (95% CI: 2.4, 3.2%) for Hispanic and 1.8% (95% CI: 1.7, 1.9%) for Non-Hispanic White beneficiaries. The cumulative incidence of 90-day ESM initiation also varied by U.S. census division, ranging from 1.5% (95% CI: 1.2, 1.8) [West North Central] to 2.4% (95% CI: 2.0, 2.7%) [East South Central]. There has been an increase in ESM 90-day initiation over time, rising from 1.7% (95% CI: 1.4, 2.0%) in 2013 to 2.3% (95% CI: 2.1, 2.6%) in 2021. Of the 3,302 ESM initiators, Levetiracetam was the most common medication choice across all years (81%).
Conclusions: Over the last decade, there has been a slight increase in ESM initiation rates. Black/African American and Hispanic beneficiaries had a higher 90-day incidence of post-AIS ESM initiation than non-Hispanic Whites. These disparities may arise from unadjusted baseline severity, in-hospital or post-discharge care disparities, and other factors requiring further investigation.
Funding: NIH (1R01AG073410-01)
Anti-seizure Medications