The New York Heart Association (NYHA) developed a functional classification for patients with heart disease.
Patient selection: Heart disease must be present.
Parameters:
(1) limitations on physical activity
(2) symptoms (undue fatigue, palpitations, dyspnea, and/or anginal pain) with ordinary physical activity
(3) status at rest
Limitations on Physical Activity |
Symptoms with Ordinary Physical Activity |
Status at Rest |
Class |
none |
none |
comfortable |
I |
slight |
symptomatic with ordinary activities |
comfortable |
II |
marked |
symptomatic at less than ordinary levels of activity |
comfortable |
III |
unable to perform any activity |
discomfort with any activity |
symptomatic at rest |
IV |
In addition, the level of objective evidence was also classified:
Objective Evidence of Cardiovascular Disease |
Class |
no evidence of disease |
A |
minimal disease |
B |
moderate disease |
C |
severe disease |
D |
Previous Classification (1964)
The NYHA classification above was introduced with the seventh edition of the manual. The AMA criteria for permanent impairment still uses an older classification.
Limitations on Physical Activity |
Symptoms with Physical Activity |
Findings at Rest |
Class |
none |
none |
comfortable at rest |
I |
slight |
symptomatic with greater than ordinary activities |
comfortable at rest |
II |
marked |
symptomatic with ordinary activities |
comfortable at rest |
III |
any activity increases symptoms |
symptomatic at less than ordinary levels of activity |
may or may not be symptomatic at rest |
IV |
where:
• Symptoms include undue fatigue, palpitations, dyspnea, heart failure or anginal pain.
NOTE: If you combined both the old and newer classifications, you would end up with 5 classed (class I = asymptomatic at increased activity levels; class V = symptomatic at rest).
Purpose: To evaluate the functional status of a patient with heart disease using the classification of the New York Heart Association (NYHA).
Specialty: Sports Medicine & Rehabilitation, Cardiology, Emergency Medicine
Objective: criteria for diagnosis, severity, prognosis, stage
ICD-10: I51.9,