Classes of Heart Failure

Updated:May 4,2016

Understand the classes of heart failure

Doctors usually classify patients' heart failure according to the severity of their symptoms. The table below describes the most commonly used classification system, the New York Heart Association (NYHA) Functional Classification. It places patients in one of four categories based on how much they are limited during physical activity.

ClassPatient Symptoms
INo limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
IISlight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
IIIMarked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IVUnable to carry on any physical activity without discomfort. Symptoms of heart failure at rest.  If any physical activity is undertaken, discomfort increases.

ClassObjective Assessment
ANo objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.
BObjective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
CObjective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.
DObjective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

For Example:
  • A patient with minimal or no symptoms but a large pressure gradient across the aortic valve or severe obstruction of the left main coronary artery is classified:
    • Function Capacity I, Objective Assessment D
  • A patient with severe anginal syndrome but angiographically normal coronary arteries is classified:
    • Functional Capacity IV, Objective Assessment A

This content was last reviewed on 04/06/2015.


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Heart Failure Questions to Ask Your Doctor

downloadable sheet 

Use these questions to ask your doctor about heart failure.