Use of healthcare claims to validate the Prevention of Arrhythmia Device Infection Trial cardiac implantable electronic device infection risk score

Abstract

Aim The Prevention of Arrhythmia Device Infection Trial (PADIT) infection risk score, developed based on a large prospectively collected data set, identified five independent predictors of cardiac implantable electronic device (CIED) infection. We performed an independent validation of the risk score in a data set extracted from U.S. healthcare claims. Methods and results Retrospective identification of index CIED procedures among patients aged ≥18 years with at least one record of a CIED procedure between January 2011 and September 2014 in a U.S health claims database. PADIT risk factors and major CIED infections (with system removal, invasive procedure without system removal, or infection-attributable death) were identified through diagnosis and procedure codes. The data set was randomized by PADIT score into Data Set A (60%) and Data Set B (40%). A frailty model allowing multiple procedures per patient was fit using Data Set A, with PADIT score as the only predictor, excluding patients with prior CIED infection. A data set of 54 042 index procedures among 51 623 patients with 574 infections was extracted. Among patients with no history of prior CIED infection, a 1 unit increase in the PADIT score was associated with a relative 28% increase in infection risk. Prior CIED infection was associated with significant incremental predictive value (HR 5.66, P < 0.0001) after adjusting for PADIT score. A Harrell’s C-statistic for the PADIT score and history of prior CIED infection was 0.76. Conclusion The PADIT risk score predicts increased CIED infection risk, identifying higher risk patients that could potentially benefit from targeted interventions to reduce the risk of CIED infection. Prior CIED infection confers incremental predictive value to the PADIT score.

Antibiotic-Eluting Envelopes for the Prevention of Cardiac Implantable Electronic Device Infections: Rationale, Efficacy, and Cost-Effectiveness

“…The score, ranging from 0 to 15 points, was used to group patients into low (0–4 points), intermediate (5–6 points), and high (≥7 points) risk groups with hospitalization rates due to CIED infection of 0.51, 1.42, and 3.41%, respectively. The predictive value of the PADIT risk score has recently been validated in a large real-world dataset comprising 54,042 procedures where each unit increase in PADIT risk score was associated with 28% increase in infection risk ( 35 ). Very recently Boriani et al have also introduced a scoring system (RI-AIAC score) based on real-life registry data including 2,675 patients ( 13 ).…”

Risk Scores for Cardiac Implantable Electronic Device Infection: Which One to Believe In?

“…An independent validation of the score was performed in a data set extracted from U.S. healthcare claims by Ahmed et al [ 28 ]. In this population, the PADIT risk score served as a predictor of higher CIED infection risk.…”

“…The PADIT, SHARIFF, and RI-AIAC scores have been validated in external cohorts. However, for the PADIT trial, the external validation cohort was particularly large, evaluating a data set of 51,623 patients from the healthcare claims [ 28 ].…”

Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis

“…The PADIT risk score, aiming to identify higher risk patients that can benefit from targeted interventions to reduce the risk of CIED infection, may provide additional predictive value, particularly if prior CIED infection is considered. 61 …”