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No Short-Term Mortality from Benzodiazepine Use Post-Acute Ischemic Stroke After Accounting for Bias
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2 2023
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Source: J Clin Epidemiol. 154:136-145
[PDF-475.82 KB]
Details:
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Alternative Title:J Clin Epidemiol
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Description:Objective:
Older adults receive benzodiazepines for agitation, anxiety, and insomnia after acute ischemic stroke (AIS). No trials have been conducted to determine if benzodiazepine use affects post-stroke mortality in the elderly.
Study Design and Setting:
We examined the association between initiating benzodiazepines within one week after AIS and 30-day mortality. We included patients ≥65 years, admitted for new non-severe AIS (NIH-Stroke-Severity[NIHSS]≤ 20), 2014–2020, with no recorded benzodiazepine use in the previous three months and no contraindication for use. We linked a stroke registry to electronic health records, used inverse-probability weighting to address confounding, and estimated the risk difference(RD). A process of cloning, weighting, and censoring was used to avoid immortal time bias.
Results:
Among 2,584 patients, 389 received benzodiazepines. The crude 30-day mortality risk from treatment initiation was 212/1,000 among patients who received benzodiazepines, while the 30-day mortality was 34/1,000 among those who did not. When follow-up was aligned on day of AIS admission and immortal time was assigned to the two groups, the estimated risks were 27/1,000 and 22/1,000, respectively. Upon further adjustment for confounders, the RD was 5 (−12 to 19) deaths/1,000 patients.
Conclusion:
The observed higher 30-day mortality associated with benzodiazepine initiation within seven days was largely due to bias.
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Pubmed ID:36572369
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Pubmed Central ID:PMC10033385
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