Abstract A075: Association of Glucagon-like Peptide-1 Receptor Agonist Use and Long-Term Mortality after Acute Ischemic Stroke

Background: Glucagon-like Peptide-1 receptor agonists (GLP-1RAs) have recently been shown to reduce major adverse cardiovascular events in patients with diabetes, obesity, or overweight with prior cardiovascular events. Limited data exists on rates of GLP-1RAs use in patients with acute ischemic stroke (AIS) and associations with stroke outcomes. Aim: We aimed to investigate temporal trends in GLP-1RAs prescriptions after AIS, and to study the association between GLP-1RAs prescription after AIS and long-term mortality. Methods: We performed a retrospective cohort study using linked electronic health record, pharmacy, and insurance claims data from 2016 to 2023 on over 11 million patients at 29 healthcare organizations across the United States. We included patients with an index hospitalization for AIS using validated ICD-10-CM codes. We calculated crude rates of GLP-1RAs prescription 90 days after discharge. Using Cox proportional hazard models, we investigated the relationship between GLP-1RAs prescription, modeled as a time-varying covariate, and long-term mortality, after adjusting for demographics and cardiovascular comorbidities. Results: We included 56,801 patients discharged after AIS. Mean age (SD) was 59 (13) years, 47% were women, and 55% were White. A GLP-1RA was prescribed to only 298 (0.5%) patients within 90 days following discharge. In the subset of 34,156 (60%) AIS patients with either diabetes or BMI ≥27, 290 (0.85%) were prescribed GLP-1RA. Stroke survivors prescribed a GLP-1RA were younger, more often had commercial insurance, had a higher median BMI, and a higher prevalence of hypertension and diabetes compared to those who were not prescribed a GLP-1RA. The crude rate of GLP-1RA prescriptions within 90 days after discharge significantly increased from 0.24% in 2016 to 0.75% in 2023 (OR per year, 1.20; 95% CI, 1.13–1.27). In adjusted Cox models, patients who were prescribed a GLP-1RA had significantly lower risk of long-term mortality compared to those who were not prescribed a GLP-1RA (HR 0.73; 95% CI, 0.53–1.00; p = 0.047), during a median follow up period of 1.4 years (IQR 0.5-3.0). Conclusions: In a large, contemporary cohort of patients with AIS, only 0.5% were prescribed GLP-1RAs at or shortly after discharge, although prescription rates increased over time. GLP-1RAs were associated with a long-term decreased risk of mortality after AIS.