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New risk score predicts cardiac-device infection

Key clinical point: Researchers have devised a five-item scoring formula to predict a patient’s risk for infection from an cardiac rhythm–device procedure.

Major finding: The risk score had an optimism-corrected concordance statistic of 0.704.

Study details: Investigators developed the risk score using data from PADIT, a multicenter, randomized trial with 19,603 patients.

Disclosures: PADIT received no commercial funding. Dr. Birnie had no relevant disclosures.

Citation:

Birnie DH. Heart Rhythm 2019, Absract S-LCT02-01.

Commentary:

I like this new infection risk score. It addresses a very clinically relevant issue. It’s important for the electrophysiology community to better understand how to best manage infections related to cardiac rhythm devices and ideally prevent them from happening.

The strength of the PADIT risk score, compared with past attempts to develop a risk-assessment tool for this situation, was the size of the database the investigators worked with: nearly 20,000 patients. This was many more patients than had ever been used before to address this question. Unfortunately, the data collected from in PADIT did not include information on their anticoagulant treatment.

I’m not a big fan of risk scores in general because they can sometimes detract from independent thinking about how to manage a patient. However, it is also helpful to have this type of risk-assessment information when discussing management options with a patient.

The PADIT risk score may also help identify which patients could potentially benefit the most from an antibiotic-eluting envelope when receiving an implanted cardiac-rhythm device. Recently reported results from WRAP-IT showed that routinely using envelopes cut the incidence of major infections by a relative 40%, but in absolute terms, the number needed to treat with the envelop to prevent one major infection was about 200 patients, a big number given the high cost of the envelope (N Engl J Med. 2019 May 16;380[20]:1895-905). It is therefore very interesting to think about using the PADIT risk score to better target an effective but expensive preventive measure like an antibiotic-eluting envelop to patients at the highest risk for infection.

Ulrika Birgersdotter-Green, MD , professor of medicine and director of pacemaker and ICD services at the University of California, San Diego, made these comments as a designated discussant for the report. She has been a consultant to and received honoraria from Abbott, Boston Scientific, and Medtronic.