New York Heart Association (NYHA) Functional Classification of Heart Failure
NYHA Class | Definition | Limitation | Example |
|---|---|---|---|
I | Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations | None | Can complete any activity requiring ≥ 7 METs:
|
II | Comfortable at rest; ordinary physical activity causes fatigue, dyspnea, palpitations, or angina | Mild | Can complete activity requiring ≥ 5 but ≤ 7 METs:
|
III | Comfortable at rest; less than ordinary physical activity causes fatigue, dyspnea, palpitations, or angina IIIa: Without recent HF exacerbation or recent resting dyspnea IIIb: With recent HF exacerbation or recent resting dyspnea | Moderate | Can complete activity requiring ≥ 2 and ≤ 5 METs:
|
IV | Symptomatic rest; any physical activity increases discomfort | Severe | Symptoms with all activities Cannot complete any activity requiring ≥ 2 METs (all activities listed above) |
HF = heart failure, MET = metabolic equivalent of task, a measure of how much energy is expended compared to remaining at rest; mph = mile per hour. | |||
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2023 Apr 18;81(15):1551. doi: 10.1016/j.jacc.2023.03.002.]. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012; Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810-1852. doi:10.1161/CIR.0b013e31829e8807; and Dolgin M, Association NYH, Fox AC, Gorlin R, Levin RI, New York Heart Association. Criteria Committee. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Lippincott Williams and Wilkins; March 1, 1994. | |||
MET values for activities are from:Herrmann SD, Willis EA, Ainsworth BE, et al. 2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities. J Sport Health Sci. 2024;13(1):6-12. doi:10.1016/j.jshs.2023.10.010 | |||