title: Predicting heart failure mortality in frail seniors: comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0.
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 6 months. 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 30 days", "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.
authors.affiliation: St Mary's General Hospital, Kitchener, Ontario, Canada.
authors.forename: Erin Y
authors.initials: EY
authors.lastname: Tjam
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
authors.forename: Stuart
authors.initials: S
authors.lastname: Smith
authors.forename: Bruce
authors.initials: B
authors.lastname: Arai
authors.forename: John
authors.initials: J
authors.lastname: Hirdes
authors.forename: Jeff
authors.initials: J
authors.lastname: Poss
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006305:Health Status Indicators; D006333:Heart Failure / Q000145:classification* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D009518:New York; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index