Discrete-Time Survival Analysis for Heart Failure Mortality Prediction
This study addresses critical methodological flaws in existing heart failure mortality prediction models, particularly target leakage arising from the inappropriate inclusion of follow-up duration as a predictor and the neglect of right-censoring structures, both of which induce substantial evaluation bias. By adopting a discrete-time person-period framework that transforms clinical records into interval-level binary events, the authors systematically compare Cox regression, complementary log-log generalized linear models (GLMs), generalized additive models (GAMs), random forests, XGBoost, random survival forests, and DeepSurv. Results demonstrate that person-period GLMs accurately reproduce the hazard ratios and concordance indices of Cox models, while GAMs achieve the best trade-off between modeling nonlinear effects and generalization performance, yielding superior predictive accuracy. Crucially, erroneously incorporating follow-up time inflates the AUC from 0.73 to nearly 1.00, clearly exposing and quantifying the severity of target leakage.