How is the severity of heart failure classified

Typically the status of patients with heart failure can be classified on the basis of symptoms, impairment of lifestyle, or severity of cardiac dysfunction. The New York Heart Association (NYHA) classification is used to assess symptomatic limitations of heart failure and response to therapy:

  • Class I: Ordinary physical activity does not cause symptoms. Dyspnea occurs with strenuous or prolonged exertion at work or with recreation.
  • Class II: Ordinary physical activity results in symptoms. Dyspnea is occurring while walking or climbing stairs rapidly or walking uphill. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace results in symptoms.
  • Class III: Less than ordinary activity results in symptoms. Dyspnea occurs with walking one to two blocks on the level or climbing one flight of stairs at a normal pace.
  • Class IV: Dyspnea occurs at low level of physical activity or at rest.

The NYHA classification describes the functional status of patients with stages C or D heart failure. The severity of symptoms characteristically fluctuates even in the absence of changes in medications, and changes in medications can have either favorable or adverse effects on functional capacity in the absence of measurable changes in ventricular function. Some patients may demonstrate remarkable recovery associated with improvement in structural and functional abnormalities. Usually sustained improvement is associated with drug therapy, and that therapy should be continued indefinitely.

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