Statistical Modelling 13 (3) (2013), 179–198

A joint survival-longitudinal modelling approach for the dynamic prediction of rehospitalization in telemonitored chronic heart failure patients

Edmund Njeru Njagi
I-BioStat,
Universiteit Hasselt,
Diepenbeek,
Belgium
e-mail: edmund.njagi@uhasselt.be

Dimitris Rizopoulos
Department of Biostatistics,
Erasmus University Medical Center,
Rotterdam,
The Netherlands


Geert Molenberghs
I-BioStat,
Universiteit Hasselt & KU Leuven,
Diepenbeek & Leuven,
Belgium


Paul Dendale
Jessa Hospital,
Heart Centre Hasselt,
Hasselt,
Belgium & Universiteit Hasselt,
Faculty of Medicine and Life Sciences,
Diepenbeek,
Belgium


Koen Willekens
Katholieke Universiteit Leuven,
Faculty of Medicine,
B-3000 Leuven,
Belgium


Abstract:

Telemonitoring in chronic heart failure involves remote monitoring, by clinicians, of daily patient measurements of biomarkers, such as blood pressure and heart rate. As a strategy in heart failure management, the aim is for clinicians to use these measurements to predict rehospitalization, so that intervention decisions can be made. This is important for clinical practice since heart failure patients have a very high rehospitalization rate. We present a dynamic prediction approach, based on calculating dynamically-updated patient-specific conditional survival probabilities, and their confidence intervals, from a joint model for the time-to-rehospitalization and the time-varying and possibly error-contaminated biomarker. We quantify the ability of the biomarker to discriminate between patients who are and those who are not going to get rehospitalized within a given time window of interest. This approach does not only provide a sound statistical modelling approach to the substantive problem, a problem which to the best of our knowledge has not previously been addressed using a statistical modelling approach, it also provides clinicians with a valuable additional tool on which to base their intervention decisions, and thus provides immense contribution to heart failure management.

Keywords:

area under the receiver operating characteristic curve (AUC); dynamic discriminative index; dynamic prediction; joint modelling

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