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Classification of Heart Failure: ACC/AHA Stage vs NYHA Class

This slide was created under the auspices of Professional Postgraduate Services® through an unrestricted educational grant.

  • The ACC/AHA writing committee has taken a new approach to the classification of HF: the evolution and progression of the disease is now emphasized. Only stages C and D qualify for the traditional clinical diagnosis of HF. (This classification is intended to complement, but not replace, the NYHA Functional Classification.)

  • Stage A: patients who are at high risk for developing HF but have no structural disorder of the heart

  • Stage B: patients with structural disorders of the heart who have never had symptoms of HF

  • Stage C: patients with past or current symptoms of HF associated with underlying structural heart disease

  • Stage D: patients with end-stage disease who require specialized treatment strategies, such as mechanical circulatory support, continuous IV inotrope infusions, cardiac transplantation, or hospice care

  • The New York Heart Association Functional Classification assigns patients to one of four functional classes, depending on the degree of effort needed to elicit symptoms. Patients with very low left ventricular ejection fractions may be asymptomatic, whereas patients with preserved LV systolic function may have many symptoms.

  • Class I: symptoms of HF only at levels that would limit normal individuals (asymptomatic)

  • Class II: symptoms of HF on ordinary exertion

  • Class III: symptoms of HF on less-than-ordinary exertion

  • Class IV: symptoms of HF at rest

  • Hunt SA et al. Circulation. 2001;104:2996-3007.

    Farrell MH et al. JAMA. 2002;287:890-897.