From the Guidelines
The New York Heart Association (NYHA) classification is a crucial tool for characterizing symptoms and functional capacity of patients with symptomatic heart failure, and it should be used to guide treatment decisions and evaluate response to therapy. The NYHA classification system categorizes heart failure patients into four classes based on their functional capacity and symptom severity [ 1 ].
Key Points of NYHA Classification
- Class I patients have cardiac disease but no limitations in physical activity, with no symptoms during ordinary activities.
- Class II patients have slight limitations, with comfortable rest but ordinary activity causing fatigue, palpitations, or shortness of breath.
- Class III patients have marked limitations, with comfortable rest but less than ordinary activity causing symptoms.
- Class IV patients have severe limitations, with symptoms even at rest and increased discomfort with any physical activity. This classification is subjective and can change over time, but it is an independent predictor of mortality [ 1 ].
Clinical Application
The NYHA classification should be reassessed regularly as heart failure can improve with treatment or worsen with disease progression, allowing for appropriate adjustments to the treatment plan [ 1 ]. Clinicians should specify NYHA classification at baseline after the initial diagnosis and after treatment through the continuum of care of a patient with heart failure. Although a patient with symptomatic heart failure may become asymptomatic with treatment, they will still be categorized according to their initial stage of heart failure [ 1 ].
From the Research
Overview of NYHA Classification
- The New York Heart Association (NYHA) classification is a system used to grade the severity of heart failure symptoms and functional impairment 2, 3, 4, 5, 6.
- The classification system ranges from Class I (no symptoms) to Class IV (severe symptoms) and is used to determine the severity of heart failure and guide treatment decisions.
Limitations of NYHA Classification
- Studies have shown that the NYHA classification system has limitations in terms of its ability to accurately stratify risk and predict outcomes in patients with heart failure 2, 3.
- The system has been found to have poor discriminative power, with significant overlap between classes in terms of symptoms, functional impairment, and prognosis 2.
- Patient-rated and physician-rated NYHA classes have been found to differ, with physician-rated classes correlating more strongly with objective measures of disease severity and prognosis 3.
Use of NYHA Classification in Guiding Treatment
- The NYHA classification system is often used to guide treatment decisions in patients with heart failure, with different classes corresponding to different treatment strategies 4, 5, 6.
- However, studies have shown that the efficacy of certain treatments, such as beta-blockers and ACE inhibitors, is independent of NYHA class, suggesting that the classification system may not be a reliable guide for treatment decisions 5.
- Other factors, such as the presence of comorbidities and the severity of left ventricular dysfunction, may be more important in determining the efficacy of treatment in patients with heart failure 5.
Prognostic Value of NYHA Classification
- The NYHA classification system has been found to have prognostic value in patients with heart failure, with higher classes corresponding to a poorer prognosis 2, 3, 5.
- However, the system has been found to have limitations in terms of its ability to accurately predict outcomes, with other factors, such as the presence of comorbidities and the severity of left ventricular dysfunction, playing a more important role in determining prognosis 2, 3, 5.