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New York Association classification of heart failure

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure (1):

  • class I no limitation of physical activity
    • ordinary physical activity does not cause fatigue, breathlessness or palpitation (includes asymptomatic left ventricular dysfunction)

  • class II slight limitation of physical activity
    • patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angina pectoris (symptomatically 'mild' heart failure)

  • class III marked limitation of physical activity
    • although patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically 'moderate' heart failure)

  • class IV inability to carry out any physical activity without discomfort
    • symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically 'severe' heart failure)

According to a study conducted, the following criteria were used by cardiologists to determine the NYHA class of a patient (cardiologists could use multiple criteria for assessment):

  • self reported walking distance - 70%
  • difficulty in climbing stairs - 60%
  • ability to walk to local landmarks - 30%
  • breathlessness interferes with daily activities - 23%
  • breathless when walking around the house - 23%
  • no specific questions - 13% (1)

This study has also pointed out that NYHA classification system is subjective and poorly reproducible since there are no clear standard criteria for assigning an NYHA class (1).

Note:

  • the functional class tends to deteriorate unevenly overtime, so the severity of the symptoms cannot be compared with the severity of the underlying problem e.g. – patients with severe disease may have mild symptoms and vice versa
  • favourable or adverse effects on functional capacity can occur with changes in medication and diet in the absence of any measurable changes in heart function (3)

Reference:


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