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Heart Failure Classifications

Heart Failure Stages and Functional Classifications

Patients’ heart failure classifications are determined by a doctor based on the their heart failure symptoms and functional limitations. The severity of heart failure depends on how well your heart is able to pump blood to your body. The most common measure of heart failure severity is based on the NYHA (New York Heart Association) Class guidelines.

NYHA Functional Classification

NYHA Class Patients with Cardiac Disease (Description of HF Related Symptoms)
Class I (Mild) Patients with cardiac disease but without resulting in limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation (rapid or pounding heart beat), dyspnea (shortness of breath), or anginal pain (chest pain).
Class II (Mild) Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain
Class III (Moderate) Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.
Class IV (Severe) Patients with cardiac disease resulting in the inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.
The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston, Mass: Little, Brown & Co; 1994:253-256.


In 2001, the American Heart Association and American College of Cardiology developed a rating system to evaluate the progression of heart failure symptoms. The following points provide a description of patient as heart failure progresses.

American Heart Association Heart Failure Stages

  • Stage A: Presence of heart failure risk factors but no heart disease and no symptoms
  • Stage B: Heart disease is present but there are no symptoms (structural changes in heart before symptoms occur)
  • Stage C: Structural heart disease is present AND symptoms have occurred
  • Stage D: Presence of advanced heart disease with continued heart failure symptoms requiring aggressive medical therapy
Yancy, C. W., et. al. “2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.” Circulation 128.16 (2013): n. pag. Print.

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