NYHA Classification and Heart Failure Staging
NYHA Classification System
- The American College of Cardiology defines the NYHA functional classification as a subjective assessment by clinicians that gauges the severity of symptoms in patients with heart failure who are in stages C or D of the ACC/AHA heart failure staging system 1, 2
- The American College of Cardiology recommends the following NYHA classes: Class I, no limitation of physical activity; Class II, slight limitation of physical activity; Class III, marked limitation of physical activity; and Class IV, unable to carry on any physical activity without symptoms of heart failure 1, 2
- Class I is characterized by no limitation of physical activity, with ordinary physical activity not causing symptoms of heart failure, according to the American College of Cardiology 2
- Class III is marked by a limitation of physical activity, with less than ordinary activity causing symptoms of heart failure, as defined by the American College of Cardiology 1, 2
- Class IV is characterized by an inability to carry on any physical activity without symptoms of heart failure, or symptoms of heart failure at rest, according to the American College of Cardiology 1, 2
Relationship to ACC/AHA Heart Failure Stages
- The American College of Cardiology states that the NYHA classification complements but does not replace the ACC/AHA staging system for heart failure 3, 4
- Stage A is defined as being at risk for heart failure but without symptoms, structural heart disease, or cardiac biomarkers of stretch or injury, according to the American College of Cardiology 2
- Stage C is characterized by structural heart disease with current or previous symptoms of heart failure, and can be classified as NYHA I, II, III, or IV depending on symptom severity, as defined by the American College of Cardiology 2
Clinical Implications of NYHA Classification
- The American College of Cardiology notes that NYHA classification is an independent predictor of mortality in heart failure patients 2
- Clinicians should specify NYHA classification at baseline after initial diagnosis and reassess after treatment throughout the continuum of care, according to the American College of Cardiology 2