Habertheuer et al. present a risk scoring system for predicting morbidity and mortality in 1181 patients undergoing surgery for drug associated endocarditis. The authors conclude that drug-related endocarditis is associated with significant morbidity and mortality and that an easily-applied risk stratification score may aid in clinical decision making. The authors demonstrate excellent predictive accuracy in a multi-institutional dataset, and the system is applicable to multivalve patients. Time will tell if application of this or other risk scoring systems can truly provide a roadmap to improved outcomes.