NYHA classification of heart failure
Choose the description that best matches the patient’s exercise tolerance. The NYHA class grades the severity of heart failure symptoms, not their cause.
Interpretation
The New York Heart Association (NYHA) classification grades how much heart failure symptoms — breathlessness, fatigue and palpitations — limit physical activity. The class is assigned by the clinician from the history, so it is subjective and may change quickly, for example after a change in treatment or during decompensation.
NYHA class carries prognostic value (a higher class means a higher risk of hospitalisation and death) and appears in the criteria for many therapies, but it does not replace assessment of ejection fraction, natriuretic peptides or physical examination.
NYHA vs ACC/AHA stages
ACC/AHA stages describe how the disease develops and — unlike NYHA classes — do not go backwards:
| Stage | Description | NYHA class |
|---|---|---|
| A | Risk factors (hypertension, diabetes, obesity) without heart changes | — |
| B | Structural or functional heart disease without symptoms | I |
| C | Current or previous symptoms of heart failure | I–IV |
| D | Advanced heart failure with symptoms despite optimal therapy | IV |
Limitations
- The assessment is subjective — two clinicians may assign different classes to the same patient.
- Symptoms may come from other conditions (COPD, anaemia, obesity, deconditioning).
- The class reflects the current state; ACC/AHA stages describe the course of the disease.
Sources
- The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston: Little, Brown & Co; 1994.
- McDonagh TA, Metra M, Adamo M i in. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726. doi.org
- Heidenreich PA, Bozkurt B, Aguilar D i in. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation 2022;145:e895–e1032. doi.org
Frequently asked questions
Can the NYHA class improve?
How does NYHA class differ from ejection fraction?
More calculators
- Unit convertersCholesterol and triglyceride converterCholesterol, LDL, HDL, TG, ApoB, Lp(a): mg/dL ↔ mmol/L
- PaediatricsGrowth percentile calculatorChild weight, height, BMI and head circumference on WHO and Polish charts
- Anthropometry and nutritionBMI calculatorAdult body mass index, healthy weight range and waist-to-height
- DiabetologyHbA1c calculatorHbA1c in % and mmol/mol, average glucose and treatment targets
- DiabetologyHOMA-IR and Matsuda indexInsulin resistance from fasting glucose and insulin and from an OGTT
- PsychiatryPHQ-9 depression testScreening questionnaire for depressive symptoms
This calculator is for education and does not replace a doctor’s assessment. Always interpret the result together with the history and examination.