Bayesian competing risks survival modeling for assessing the cause of death of patients with heart failure

Competing risks models are survival models with several events of interest acting in competition and whose occurrence is only observed for the event that occurs first in time. This paper presents a Bayesian approach to these models in which the issue of model selection is treated in a special way by proposing generalizations of some of the Bayesian procedures used in univariate survival analysis. This research is motivated by a study on the survival of patients with heart failure undergoing cardiac resynchronization therapy, a procedure which involves the implant of a device to stabilize the heartbeat. Two different causes of death have been considered: cardiovascular and non-cardiovascular, and a set of baseline covariates are examined in order to better understand their relationship with both causes of death. Model selection, model checking, and model comparison procedures have been implemented and assessed. The posterior distribution of some relevant outputs such as the overall survival function, cumulative incidence functions, and transition probabilities have been computed and discussed.