{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:01:28Z","timestamp":1792094488824,"version":"4.4.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9\u20136.1];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.0001), C-reactive protein &gt;50 mg\/L (hazard ratio, 3.0 [95% CI, 1.4\u20136.4];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6\u201317.9];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6\u20134.1];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.001), and in all patients (n=12\u2005198, event rate: 1%, area under the curve, 0.8 versus 0.75,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores \u22656 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, \u00a318\u2005446).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>\n              The BLISTER score (\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/qxmd.com\/calculate\/calculator_876\/the-blister-score-for-cied-infection\">https:\/\/qxmd.com\/calculate\/calculator_876\/the-blister-score-for-cied-infection<\/jats:ext-link>\n              ) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.123.012446","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T07:00:10Z","timestamp":1705993210000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6177-2221","authenticated-orcid":true,"given":"Edd","family":"Maclean","sequence":"first","affiliation":[{"name":"Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew\u2019s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)."},{"name":"William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0467-6732","authenticated-orcid":true,"given":"Karishma","family":"Mahtani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew\u2019s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohreh","family":"Honarbakhsh","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew\u2019s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)."},{"name":"William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1518-2671","authenticated-orcid":true,"given":"Charles","family":"Butcher","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew\u2019s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1257-5576","authenticated-orcid":true,"given":"Nikhil","family":"Ahluwalia","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew\u2019s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. 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