Is the New York Heart Association (NYHA) functional classification used to describe the degree of physical disability and determine entry criteria for clinical research trials?

From the Guidelines

The statement is true. The New York Heart Association (NYHA) functional classification is indeed commonly used by physicians after completing a thorough history and physical examination to describe the degree of physical disability in patients with heart failure. This classification system categorizes patients into four classes (I through IV) based on their symptoms during physical activity, with Class I representing no limitation of physical activity and Class IV indicating symptoms at rest.

Key Points

• The NYHA classification is valuable because it provides a standardized way to communicate about a patient's functional status and to track changes in their condition over time or in response to treatment 1.
• Additionally, the NYHA class is frequently used as an entry criterion or stratification factor in clinical research trials studying heart failure treatments, as it helps researchers ensure appropriate patient selection and compare outcomes across similar functional groups 1.
• The NYHA functional classification is an independent predictor of mortality, and it is widely used in clinical practice to determine the eligibility of patients for treatment strategies 1.
• Although reproducibility and validity can be limited, the NYHA functional classification is a useful tool in both clinical practice and research 1.

Clinical Use

The NYHA classification is used to characterize symptoms and functional capacity of patients with symptomatic heart failure, and it is a subjective assessment by a clinician that can change over time 1.

• Clinicians specify NYHA classification at baseline after the initial diagnosis and after treatment through the continuum of care of a patient with heart failure 1.
• The NYHA classification is also used to determine the eligibility of patients for certain healthcare services and to select patients for randomized treatment trials in heart failure 1.

From the Research

Description of the New York Heart Association (NYHA) Functional Classification

• The NYHA functional classification is a widely used metric in heart failure (HF)-oriented clinical care and research 2, 3, 4, 5, 6.
• It is used to describe the degree of physical disability a patient has, with classes ranging from I (no symptoms) to IV (severe symptoms) 2, 3, 4, 5, 6.

Use of NYHA Classification in Clinical Practice

• Physicians commonly use the NYHA classification to help determine the degree of physical disability a patient has, after completing a thorough history and physical exam 2, 3, 4, 5, 6.
• The NYHA classification is also used to determine entry criteria for patients participating in clinical research trials 2, 3, 4, 5, 6.

Limitations of the NYHA Classification

• The NYHA system has been shown to poorly discriminate HF patients across the spectrum of functional impairment 2, 4.
• There is substantial overlap in values for objective measures such as NT-proBNP levels, KCCQ scores, and 6-minute walk distances between different NYHA classes 2, 4.
• The NYHA classification may not accurately reflect the severity of symptoms or the level of ventricular systolic dysfunction 3, 4.

Answer to the Question

• Based on the evidence, the statement is: True. Physicians will commonly use the NYHA functional classification to help describe the degree of physical disability a patient has, and it is also used to determine entry criteria for patients participating in clinical research trials 2, 3, 4, 5, 6.