Can the Charlson comorbidity index help to guide DOAC dosing in patients with atrial fibrillation and improve the efficacy and safety of treatment? A subanalysis of the MAS study

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2024-10-30 DOI:10.1016/j.cpcardiol.2024.102913

Gualtiero Palareti , Cristina Legnani , Sophie Testa , Oriana Paoletti , Michela Cini , Emilia Antonucci , Vittorio Pengo , Daniela Poli , Walter Ageno , Paolo Prandoni , Domenico Prisco , Alberto Tosetto , the MAS Working Group

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引用次数: 0

Abstract

Background

Frailty influences the effectiveness and safety of anticoagulant therapy in patients with atrial fibrillation (AF). The age-weighted Charlson comorbidity index may offer a valuable tool to assess the risk of adverse events in AF patients treated with direct oral anticoagulants (DOACs). This sub-analysis of MAS trial data aimed to assess whether using the Charlson index, instead of the standard criteria, would have led to different dosing and improved adverse event occurrence during treatment.

Methods

The MAS study looked for a relationship between DOAC levels assessed at baseline and adverse events during follow-up. The study is described in detail elsewhere.

Results

Among the 1,657 patients studied, 832 (50.2 %) had a relatively low Charlson index (up to 6, general median class), of whom 132 (15.9 %) were treated with reduced doses. Conversely, among the 825 patients with a high Charlson index (≥7), 257 (31.1 %) received standard doses. A weak but statistically significant positive correlation (r = 0.1413, p < 0.0001 by ANOVA) was observed between increasing Charlson classes and DOAC levels standardized to allow comparability among drug results. However, no significant differences were found in the incidence or number of adverse events during follow-up, or in other parameters, between patients with low and high Charlson's scores.

Conclusions

Utilizing the Charlson index would have led to notable differences in DOAC dosing compared to standard criteria. However, we found no evidence that its use would have improved the prediction of adverse events in AF patients enrolled in the MAS study.

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查尔森合并症指数能否帮助指导心房颤动患者的 DOAC 剂量并提高治疗的有效性和安全性？MAS 研究的子分析：心房颤动患者的 Charlson 指数和 DOAC 剂量。

背景：虚弱会影响心房颤动（房颤）患者抗凝治疗的有效性和安全性。年龄加权的查尔森合并症指数可为评估接受直接口服抗凝剂（DOACs）治疗的房颤患者发生不良事件的风险提供有价值的工具。本研究对 MAS 试验数据进行了子分析，旨在评估使用 Charlson 指数而非标准标准是否会导致不同的用药剂量并改善治疗期间的不良事件发生率：MAS研究寻找基线评估的DOAC水平与随访期间不良事件之间的关系。该研究在其他地方有详细描述：在接受研究的 1,657 名患者中，832 人（50.2%）的查尔森指数相对较低（最高为 6，一般中位分级），其中 132 人（15.9%）接受了减量治疗。相反，在 825 名夏尔森指数较高（≥7）的患者中，有 257 人（31.1%）接受了标准剂量治疗。在夏尔森等级增加与 DOAC 水平标准化之间观察到微弱但有统计学意义的正相关（r = 0.1413，方差分析 p = 0.0001），以便在不同药物结果之间进行比较。然而，在随访期间不良事件的发生率或数量或其他参数方面，Charlson评分低和高的患者之间没有发现明显差异：结论：与标准标准相比，使用 Charlson 指数会导致 DOAC 剂量的显著差异。然而，我们没有发现任何证据表明使用该指数会改善对 MAS 研究中房颤患者不良事件的预测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.