HEART FAILURE CLASSIFICATION (Page 1)
New York Heart Association Classification
Level Description Simple Description I Cardiac disease without resulting limitations of physical activity. Asymptomatic. II Slight limitation of physical activity - comfortable at rest, but ordinary physical activity results in fatigue, dyspnea, or anginal pain. Symptomatic with moderate exertion. III Marked limitation in physical activity - comfortable at rest, but less than ordinary physical activity causes fatigue, dyspnea, or anginal pain. Symptomatic with minimal exertion. IV Inability to carry on any physical activity without discomfort of symptoms at rest. Symptomatic at rest.
ACC/AHA Stages of Heart Failure, 2001 (New classification, supplement to NYHA Classification)
Stage Description Examples A
Patients at high risk of developing HF because of the presence of conditions that are strongly associated with the development of HF. Such patients have no identified structural or functional abnormalities of the pericardium, myocardium or cardiac valves and have never shown signs or symptoms of HF.
Systemic hypertension; coronary artery disease; diabetes mellitus; history of cardiotoxic drug therapy or alcohol abuse; personal history of rheumatic fever; family history of cardiomyopathy.
B Patients who have developed structural heart disease that is strongly associated with the development of HF but who have never shown signs or symptoms of HF. Left ventricular hypertrophy or fibrosis; left ventricular dilatation or hypocontractility; asymptomatic valvular heart disease; previous myocardial infarction. C Patients who have current or prior symptoms of HF associated with underlying structural heart disease. Dyspnea or fatigue due to left ventricular systolic dysfunction; asymptomatic patients who are undergoing treatment for prior symptoms of HF. D Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions. Patients who are frequently hospitalized for HF and cannot be safely discharged from the hospital; patients in the hospital awaiting heart transplantation; patients at home receiving continuous intravenous support for symptom relief or being supported with a mechanical circulatory assist device; patients in a hospice settling for the management of HF.
Heart Failure Classification (ACC/AHA 2001 and NYHA)
ACC/AHA, 2001 NYHA A At high risk of developing HF, but without structural heart disease or symptoms of HF None . B Structural heart disease, but without symptoms of HF I
C Structural heart disease with prior or current symptoms of HF II
Symptomatic with moderate exertion
Symptomatic with minimal exertion
Symptomatic at rest
IV D Refractory HF requiring specialized interventions
ACC = American College of Cardiology. AHA = Americal Heart Association. NYHA = New York Heart Association. HF = Heart Failure.