Functional Classification of Heart Disease

A commonly used classification system to quantify and monitor the severity of symptoms in the management of patients with heart disease is that of the New York Heart Association (NYHA), shown below: 

• Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or anginal pain.
• Class II: Slight limitation of physical activity. Ordinary physical activity results in symptoms.
• Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms.
• Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.

 

Other classifications have been proposed, but these are universally accepted, and clinically can be applied to both heart failure and anginal symptoms. Some experts use the category of Class V to describe symptoms that are atypical and can occur either at rest or with exertion.

A task force from the American College of Cardiology/American Heart Association (ACC/AHA) proposed that patients with heart failure be classified into four stages:

• Stage A: Those at high risk for congestive heart failure (CHF) but no structural heart disease (ie, hypertension, coronary artery disease [CAD]) and no symptoms.
• Stage B: Those with structural heart disease associated with CHF and no symptoms.
• Stage C: Those with structural heart disease who have current or prior symptoms.
• Stage D: Those with refractory CHF requiring some device or special intervention.