How is NYHA class used in treatment decisions?

NYHA class guides therapy escalation: Class I patients typically receive ACE inhibitors/ARBs and beta-blockers. Class II-III patients may additionally receive aldosterone antagonists, ARNI, and SGLT2 inhibitors. Class III-IV patients may need advanced therapies including ICD, CRT, inotropes, mechanical support (LVAD), or transplant evaluation.

Can NYHA class change over time?

Yes, NYHA class is dynamic and can improve with treatment or worsen with disease progression. A patient may be Class III at diagnosis but improve to Class I-II with optimal medical therapy. Conversely, decompensation can move patients to a higher class. Serial NYHA assessment helps track treatment response.

What is the mortality by NYHA class?

5-year mortality increases substantially with NYHA class: Class I: 5–10%, Class II: 10–20%, Class III: 20–50%, Class IV: 1-year mortality 50–75%. However, modern heart failure therapies have significantly improved outcomes across all classes.

Online Medical Tools — NYHA Classification

Printed on 2/13/2026

For informational purposes only. This is not medical advice.

Cardiology

NYHA Classification

The New York Heart Association (NYHA) Functional Classification is the most commonly used system for describing the severity of heart failure symptoms. It classifies patients into four classes based on how much they are limited during physical activity: Class I (no limitation), Class II (slight limitation — symptoms with ordinary activity), Class III (marked limitation — symptoms with less than ordinary activity), and Class IV (unable to carry on any activity without discomfort — symptoms at rest). NYHA class is used in treatment guidelines, clinical trials, and prognostication.

Compare with CHA₂DS₂-VASc Score

Formula: Subjective classification based on physical activity tolerance. Classes I–IV.

Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.