A patient requiring insertion of a left ventricular assist device (LVAD) is categorized using the INTERMACS classification. This provides greater detail than that provided by NYHA Stage IV.
INTERMACS = Interagency Registry for Mechanically Assisted Circulatory Support
Descriptor
INTERMACS Category
Clinical Features
critical cardiogenic shock
1
life-threatening hypotension despite intravenous inotropic support
progressive decline (deterioration)
2
clinical deterioration despite intravenous inotropic support
inotrope dependent but stable
3
stable while on intravenous inotropic support but unable to be weaned
symptoms at rest
4
stable but with episodes of symptomatic congestion at rest; intolerant of any activity
exertion intolerant
5
stable and asymptomatic at rest but cannot engage in any exertion
exertion limited
6
stable and asymptomatic at rest and can engage in minimal physical exertion
limited to mild exertion (advanced NYHA III)
7
stable and asymptomatic at rest and can engage in mild physical exertion
Exertion Tolerated
Symptoms at Rest
Need for Inotropes
Category
mild
none
none
7
minimal
none
none
6
none
none
none
5
none
yes, may be episodic
none
4
none
yes, stable
yes
3
none
yes, deteriorating
yes
2
none
yes, end-stage shock
yes
1
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