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Cardiology
NYHA Heart Failure Classification
🫀 Cardiology
NYHA Heart Failure Classification
Functional classification of heart failure severity based on symptoms and activity limitation
Overview
The NYHA classification system is the standard method for classifying heart failure functional capacity. It guides treatment decisions and correlates with prognosis, quality of life, and eligibility for device therapy.
Symptom Assessment
Question 1: Does the patient have symptoms at rest?
Question 2: Do symptoms occur with less than ordinary activity? (e.g., dressing, washing)
Question 3: Do symptoms occur with ordinary activity? (e.g., walking on level ground, climbing stairs)
NYHA Classification
Class —
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NYHA Classification Reference
| Class | Description | 5-Year Mortality |
|---|---|---|
| I | No symptoms with ordinary activity, no limitation | ~18% |
| II | Slight limitation; comfortable at rest, symptoms with ordinary activity | 18–35% |
| III | Marked limitation; comfortable only at rest, symptoms with less-than-ordinary activity | ~50% |
| IV | Severe limitation; symptoms at rest, unable to carry out any physical activity | 50–75% |
Clinical Notes:
• ICD implantation indicated for Class II–III with EF ≤35% on optimal medical therapy
• CRT indicated for Class III–IV with EF ≤35% and LBBB ≥150ms
• NYHA Class correlates with ACC/AHA Stages B–D
• Classification should be reassessed after initiating or uptitrating medical therapy
• Class IV patients should be considered for advanced HF therapies (LVAD, transplant)
• ICD implantation indicated for Class II–III with EF ≤35% on optimal medical therapy
• CRT indicated for Class III–IV with EF ≤35% and LBBB ≥150ms
• NYHA Class correlates with ACC/AHA Stages B–D
• Classification should be reassessed after initiating or uptitrating medical therapy
• Class IV patients should be considered for advanced HF therapies (LVAD, transplant)
⚕️ For use by qualified healthcare professionals only. Not a substitute for clinical judgment.