New York Heart Association (NYHA) Functional Classification

Your physician will likely “classify” your heart failure condition according to the severity of your symptoms. This classification system, known as the New York Heart Association (NYHA) Functional Classification, places you into one of four categories based on your physical activity limitations.

Class I

No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation (feeling heart beats), or dyspnea (shortness of breath).

Class II(Mild)

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.

Class III(Moderate)

Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.

Class IV(Severe)

Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

Stages of Heart Failure

The stages classified by the AHA and ACC are different than the New York Heart Association (NYHA) clinical classifications of heart failure that rank patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your doctor what stage of heart failure you are in.

   Stage A

Presence of heart failure risk factors but no heart disease and no symptoms

Stage B

Heart disease is present but there are no symptoms(structural changes in heart before symptoms occur)

Stage C

Structural heart disease is present AND symptoms have occurred

Stage D

Presence of advanced heart disease with continued heart failuresymptoms requiring aggressive medical therapy

*Source: The American College of Cardiology and the American Heart Association Stages of Heart Failure