NYHA Functional Classification

How to use it

1. 1

   Assess exercise tolerance. Ask patient: 'What limits you?' and 'How far can you walk on the flat?'

2. 2

   Classify. NYHA I = unlimited; II = 2+ flights or long walking limited; III = <100 m limited; IV = dyspnoeic at rest.

3. 3

   Document and review. NYHA class guides drug doses, device therapy eligibility (ICD: LVEF ≤35% + NYHA II–III), and transplant listing.

When to use it

Heart failure management and drug optimisation

GDMT (carvedilol, sacubitril/valsartan, spironolactone, SGLT2i) targets improvement in NYHA class and mortality.

Device therapy indication

CRT: NYHA II–III + LVEF ≤35% + LBBB + QRS ≥130 ms. ICD: NYHA II–III + LVEF ≤35% (NICE TA314).

Advanced HF referral

Persistent NYHA III–IV despite optimal GDMT: refer to advanced HF centre for transplant/LVAD evaluation.