A Novel Tool for Visualizing Composite Endpoint Associations
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Composite end points play a major role in cardiovascular clinical epidemiology, with many studies examining, for example, the time to the first major adverse cardiac event. Beyond the cardiovascular field, progression-free survival is an important outcome in oncology, and even general mortality can be considered a composite of cause-specific mortalities. Although the common application of composite end points supports their popularity and usefulness, disadvantages and caveats also have been pointed out.1 One difficulty in composite end point studies is the transparent reporting of results in an accessible way, most authors suggesting the side-to-side reporting of results pertaining to separate analyses of the composite end point and its individual components.
Composite end point associations depend on the individual component associations in a complex way. Study duration may further complicate this through 2 main mechanisms. First, the association with any of the component outcomes may be time-varying. Second, the relative importance of the component outcomes may change with time.2 Such study duration–dependent issues are likely to affect a substantial proportion of composite end point studies, but current analysis and reporting practices might often fail to reveal this. Thus, a straight-forward graphical summary of composite end …