New York Heart Association (NYHA) Functional Classification

Classification system for: Heart failure 

Classified by

• Objective assessment (A-D)

and

• Patient symptoms (I-IV)

Objective assessment

A: No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity. B: Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest. C: Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest. D: Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

 

Patient symptoms

I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II: Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
III: Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IV: Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

 

Example

NYHA Class IV-D

• Objective evidence of severe cardiovascular disease. 
• Severe limitations. 
• Experiences symptoms even while at rest. 
• Unable to carry on any physical activity without discomfort. 
• Symptoms of heart failure at rest. 
• If any physical activity is undertaken, discomfort increases.