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Activity Number:
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358
- Contributed Poster Presentations: Section on Statistics in Epidemiology
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Type:
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Contributed
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Date/Time:
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Tuesday, July 30, 2019 : 10:30 AM to 12:20 PM
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Sponsor:
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Section on Statistics in Epidemiology
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Abstract #305224
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Title:
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Estimating the Causal Effect of Digoxin on Adverse Events in LVAD Patients Using Marginal Structural Models
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Author(s):
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Katherine Hoffman* and Ivan Diaz and Alberto Pinsino and Paolo Colombo and Melana Yuzefpolskaya and Antonia Gaudig and Eugene Royzman and Melissa Mabasa and Giulio Mondellini
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Companies:
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Weill Cornell Medicine and Weill Medical College, Cornell University and Columbia University Medical Center and Columbia University Medical Center and Columbia University Medical Center and Columbia University Medical Center and Columbia University Medical Center and Columbia University Medical Center and Columbia University Medical Center
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Keywords:
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marginal structural model;
heart failure;
digoxin;
cox;
causal inference
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Abstract:
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Digoxin is one of the oldest treatments for heart failure. Recent observational studies have shown strong associations with adverse events (AEs), while older randomized clinical trials showed it to be safe. We studied the effect of Digoxin on AEs using a longitudinal, observational cohort of 207 patients implanted with a Left Ventricular Assist Device (LVAD) at Columbia University Medical Center. Cox models with 1:1 propensity score matching at baseline showed the hazard ratio of AEs for patients taking Digoxin to be 1.8 (95% CI: 1.4-26), similar to previous observational studies. However, Cox models are known to yield biased results in the presence of a time varying exposure and time dependent confounders. We adjusted for time dependent confounding through a marginal structural Cox model, using the time-varying probabilities of censoring and treatment to construct inverse probability weighted estimators. This model showed the effect of Digoxin on AEs to be non-significant 1.1 (0.7-1.7), consistent with older randomized trials. Our results suggest Digoxin is still a safe treatment for modern heart failure patients.
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Authors who are presenting talks have a * after their name.
