New York Heart Association Classification: What Does it Mean For You?

If you’ve been diagnosed with heart failure, chances are you have heard about the New York Heart Association (NYHA) classification. This is a tool used by doctors to assign a risk status to individuals based on their heart failure symptoms. Often, it is also used to determine whether the individual is eligible for certain medications and devices. In fact, many drugs and devices are monitored for their success based on their ability to improve, or maintain, the baseline classification.

The NYHA classification assesses one’s limitations to various physical activities and is used to measure the progression of heart failure. What does this categorization mean for you, as a patient?

Background of classifications

The NYHA classification has been used for nearly a century.¹ It was first described in the year 1928, and was later updated in 1994. It classifies heart failure into the following categories:¹

• Class I – People in this class have no limitations during ordinary physical activity, meaning that ordinary activities do not cause fatigue or shortness of breath. Activities that can be performed in Class I include jogging or walking at 5 mph, engaging in recreational activities like baseball, and perform outdoor activities like shoveling.
• Class II – This class describes people who have slight symptoms such as fatigue and shortness of breath during moderate physical activity, yet show no symptoms at rest. People in Class II can typically walk at 4 mph, have intercourse without needing to stop, and garden.
• Class III – People who have symptoms while performing some activity of daily living, yet who are comfortable at rest, fall into this class. Activities that can still be performed include dressing and/or showering without pausing, making the bed, and walking at 2.5 mph.
• Class IV – This is the most severe classification. People in Class IV cannot perform any physical activities without experiencing discomfort.

Limitations

The NYHA classification can be quite subjective, subject to the clinician and patient response. For example, your understanding of regular activities may differ from your clinician’s. Or, your doctor may interpret a symptom that you think is mild as severe. Sometimes, specialists may ask for your walking distance. Walking distance has not been shown to have any correlation with your actual exercise capacity.³ Furthermore, this study also highlighted that different cardiologists score NYHA differently. For example, 2 cardiologists agreed on classification for the same patient only 54% of the time.³

Furthermore, the classification has a poor correlation with survival rates. People can also move in and out of the classes; someone who was in Class IV due to a blood clot, for example, may move to class I within one month after recovering.

What it means for heart failure patients

It is a common practice to try to classify and compartmentalize conditions in science. If your doctor informs you of your NYHA class, remember that it rarely reflects the bigger picture. If you have class III or IV, it does not necessarily mean you will be there forever, and it certainly does not mean that you have failed as a patient. What is more important is how you feel, and defining objective measures of monitoring with your doctor.