Heart Failure (Cardiac Insufficiency): Classification

According to NYHA (New York Heart Association) guidelines, heart failure is classified as follows (defined in 1928).

Classification Clinic Cardiac output (CV) End-diastolic ventricular pressure
NYHA I(asymptomatic) Absence of symptoms at rest normal under stress increased under load
NYHA II(mild) Impaired exercise capacity with greater physical exertion Normal under load elevated at rest
NYHA III(moderate) Marked limitation of performance even with low exertion, but no discomfort at rest Diminished under load increased at rest
NYHA IV(severe) Complaints already at rest (resting insufficiency) Diminished at rest greatly increased at rest

Stages of heart failure according to AHA (American Heart Association)/ACC (American College of Cardiology):

Stage Clinic
A
  • High risk for developing heart failure, e.g., patients with arterial hypertension (high blood pressure), atherosclerosis (arteriosclerosis; hardening of the arteries), diabetes mellitus, obesity (overweight), metabolic syndrome
  • No structural heart disease
  • No symptoms of heart failure
B
C
  • Structural heart disease, e.g., patients with known heart disease and dyspnea (shortness of breath) and fatigue
  • Previous or current symptoms of heart failure.
D
  • Refractory (“unmanageable”) heart failure requiring special intervention, e.g., patients with symptoms at rest despite extensive medical therapy