New York Heart Association (NYHA) Functional Classification for Heart Failure
Stratifies severity of heart failure by symptoms.
- Assign NYHA Class based on patient-reported symptoms and functional limitation during usual activity.
- Determine whether symptoms occur with ordinary activity, less-than-ordinary activity, or at rest.
Advice
Management decisions should not rely on NYHA Class alone.
- Use alongside clinical context, objective measures of heart failure severity, and additional functional capacity data, and other classification methods (e.g., ACC/AHA staging); examples of additional data may include:
- Echocardiographic measures (e.g., ejection fraction).
- Biomarkers (e.g., BNP or NT-proBNP).
- Exercise capacity (e.g., 6-minute walk test).
- Patient-reported outcomes (e.g., Kansas City Cardiomyopathy Questionnaire).
- Classification may help guide therapy intensification and support comprehensive evaluation for advanced therapies.
Management
- Use results to contextualize symptom burden and help guide heart failure management.
- Results can help assess functional limitations, which are important when considering therapies, such as cardiac resynchronization therapy, certain guideline-directed medical therapies, and advanced heart failure therapies.
Critical Actions
Clinical decision-making should prioritize identification of decompensated heart failure or high-risk features that may provide important additional clinical context.