NYHA Functional Classification

Classifies the severity of heart disease such as heart failure into Class I to IV by the limit on physical activity and the symptoms it brings on

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Limit on physical activity and the symptoms it brings on (choose the one class that fits)

Class I (No limitation of physical activity)

IClass I: Has heart disease but no limit on physical activity. Ordinary activity does not cause undue fatigue, palpitation, shortness of breath or anginal pain

Class II (Slight limitation of physical activity)

IIClass II: Comfortable at rest, but ordinary activity brings on fatigue, palpitation, shortness of breath or anginal pain, so physical activity is slightly limited

Class III (Marked limitation of physical activity)

IIIClass III: Comfortable at rest, but less than ordinary activity brings on fatigue, palpitation, shortness of breath or anginal pain, so physical activity is markedly limited

Class IV (Unable to carry on any physical activity without discomfort)

IVClass IV: Cannot do any physical activity without discomfort. Symptoms of heart failure or angina can be present even at rest, and any activity makes the discomfort worse

Interpretation

Grade	Interpretation
I	Class I (No limitation of physical activity)
II	Class II (Slight limitation of physical activity)
III	Class III (Marked limitation of physical activity)
IV	Class IV (Unable to carry on any physical activity without discomfort)

Cautions

A classification of the severity of heart disease by the limit on physical activity and the symptoms it brings on, widely used for heart failure. The person doing the assessment chooses the class from the symptoms and how active the patient is.
It is separate from the heart failure stage classification (A to D). In the table of a Japanese guideline, Stages A and B are "not applicable" to the NYHA classification, and a patient in Stage C can be in any of NYHA Class I to IV. Stage C also includes past symptoms, so the stage classification alone can be hard to use for judging severity.
The same Japanese guideline defines Stage D (treatment-resistant heart failure) as patients who are admitted for heart failure about 2 or more times a year and do not improve beyond NYHA Class III despite full treatment.

References

The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. 1994. (original not seen)[Original article]
Raphael C, Briscoe C, Davies J, Whinnett ZI, Manisty C, Sutton R, Mayet J, Francis DP. Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure. Heart. 2007;93(4):476-482. (Table 1 (the NYHA classification, reproduced from the 1964 edition of the Criteria Committee's Nomenclature and criteria)) https://pmc.ncbi.nlm.nih.gov/articles/PMC1861501/[Review article]
Japanese Circulation Society and Japanese Heart Failure Society Joint Guideline. Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure (JCS 2017/JHFS 2017) (in Japanese). Published 2018-03-23. (Table 8 (heart failure stages and the NYHA classification) and the text on stages C and D that precedes it) https://www.mhlw.go.jp/file/05-Shingikai-10901000-Kenkoukyoku-Soumuka/0000202651.pdf[Guideline]

Checked on: 2026-11-07

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NYHA Functional Classification

Cautions

References

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