Predicting heart failure mortality in frail seniors: Comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0

TitlePredicting heart failure mortality in frail seniors: Comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0
Publication TypeJournal Article
Year of Publication2011
AuthorsTjam E.Y, Heckman G.A, Smith S., Arai B., Hirdes J., Poss J., McKelvie R.S
JournalInt J Cardiol
Date PublishedFeb 1
ISBN Number1874-1754 (Electronic)<br/>0167-5273 (Linking)
Accession Number21292334
Abstract

BACKGROUND: Though the NYHA functional classification is recommended in clinical settings, concerns have been raised about its reliability particularly among older patients. The RAI 2.0 is a comprehensive assessment system specifically developed for frail seniors. We hypothesized that a prognostic model for heart failure (HF) developed from the RAI 2.0 would be superior to the NYHA classification. The purpose of this study was to determine whether a HF-specific prognostic model based on the RAI 2.0 is superior to the NYHA functional classification in predicting mortality in frail older HF patients. METHODS: Secondary analysis of data from a prospective cohort study of a HF education program for care providers in long-term care and retirement homes. Univariate analyses identified RAI 2.0 variables predicting death at 6months. These and the NYHA classification were used to develop logistic models. RESULTS: Two RAI 2.0 models were derived. The first includes six items: "weight gain of 5% or more of total body weight over 30days", "leaving 25% or more food uneaten", "unable to lie flat", "unstable cognitive, ADL, moods, or behavioural patterns", "change in cognitive function" and "needing help to walk in room"; the C statistic was 0.866. The second includes the CHESS health instability scale and the item "requiring help walking in room"; the C statistic was 0.838. The C statistic for the NYHA scale was 0.686. CONCLUSIONS: These results suggest that data from the RAI 2.0, an instrument for comprehensive assessment of frail seniors, can better predict mortality than the NYHA classification.

DOI10.1016/j.ijcard.2011.01.031
Link

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dop...https://pdf.sciencedirectassets.com/271057/1-s2.0-S0167527312X00020/1-s2...