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Heart Disease | New York Heart Association Functional Classification

Purpose: To evaluate the functional status of a patient with heart disease using the classification of the New York Heart Association (NYHA).

Description

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).

 


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Specialty

Objective

ICD-10