Classifying Heart Failure

The literature reveals three major heart failure classification systems used to guide treatment plans. The New York Heart Association classifies patient status by the type and level of functional impairment related to HF. The American College of Cardiology and the American Heart Association Stages of Heart Failure focus on the structural cardiovascular changes responsible for symptoms. The European Society of Cardiology classifies HF in terms of the hearts ability to function as a pump.

New York Heart Association (NYHA) Functional Classification

The original NYHA Functional Classification was published in 1928. This was a time before important diagnostic modalities like the portable ECG, echocardiogram, exercise stress test and the cardiovascular disease biomarker B-type natriuretic peptide (BNP) assay.

The NYHA classification has been updated many times. Today's version includes two sections; 1) a subjective description of functional capacity and 2) an objective diagnostic assessment of cardiovascular disease. While subjective inconsistencies may result when classifying patients in class II or III, functional capacity remains a powerful prognostic indicator and is routinely used for clinical staging of heart failure today.

American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF)

European Society of Cardiology (ESC)

The ESC promotes 1) preventing heart failure in patients at risk, 2) identifying and treating people with early signs of abnormal heart muscle remodeling because once heart failure is established it is rarely reversed and 3) correctly diagnosing the type of heart failure because currently no therapies have been shown to extend life for those patients with HF with preserved ejection fraction (HFpEF) (Ponikowski, 2014).

The ESC staging system identifies three types of heart failure.


New York Heart Association (NYHA) Functional Classification

The Criteria Committee of the New York Heart Association. (1994). Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. (9th ed.). Boston: Little, Brown & Co. pp. 253–256.

Papadimitriou, L., Moore, C. K., Butler, J. & Long, R.C. (2019). The Limitations of Symptom-based Heart Failure Management. Card Fail Rev. 5(2), 74–77.

American Heart Association

American Heart Association. Professional Heart Daily. Accessed 8/2/16

Yancy, C. W., et. al. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.” Circulation.128(16).

European Society of Cardiology Heart Failure Guidelines

Ponikowski, P., Voors A., Anker S., Bueno H., Cleland J., Coats A., et al. (2016). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 37(27), 2129-2200.

Karamitsos, T. D., Francis, J. M., Myerson, S., Selvanayagam, J. B. & Neubauer, S. (2009). The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure. Journal of the American College of Cardiology. 54(15), 1407-1424.