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. Author manuscript; available in PMC: 2012 Jan 1.
Published in final edited form as: Drug Discov Today Dis Models. 2011 Winter;8(4):161–166. doi: 10.1016/j.ddmod.2011.02.006

Table 1.

Functional Classifications and Disease Progression Stages of Heart Failure

New York Heart Association Functional (NYHA) Classes

Definition Examples

NYHA Class I No limitation of physical activity Ordinary physical activity does not
cause undue fatigue, palpitation, or
dyspnea (shortness of breath)
NYHA Class II Slight limitation of physical
activity
Comfortable at rest, but ordinary
physical activity results in fatigue,
palpitation, or dyspnea
NYHA Class III Marked limitation of physical
activity
Comfortable at rest, but less than
ordinary activity causes fatigue,
palpitation, or dyspnea
NYHA Class IV Unable to carry out any physical
activity without discomfort
Symptoms of cardiac insufficiency
at rest. If any physical activity is
undertaken, discomfort is increased
American College of Cardiology/American Heart Association Stages of Heart Failure

Definition Examples

Stage A High risk for developing HF, but
without structural heart disease or
symptoms of HF
Hypertension, diabetes mellitus,
CAD, family history of
cardiomyopathy
Stage B Structural heart disease, but
asymptomatic
Previous myocardial infarction, left
ventricular dysfunction, valvular
heart disease
Stage C Structural heart disease with
previous or current symptoms, but
managed with medical treatment
Structural heart disease, dyspnea
and fatigue, impaired exercise
tolerance
Stage D Marked symptoms at rest despite
maximal medical therapy
Advanced disease requiring
hospital-based support, a heart
transplant or palliative care