7
Table 5. Physiological Variables as Used in ACHD AP
Classification
Variable Description
NYHA functional
classification system
Functional Capacity
I. Patients with cardiac disease but resulting in no limitation of
physical activity: Ordinary physical activity does not cause
undue fatigue, palpitation, dyspnea, or anginal pain.
II. Patients with cardiac disease resulting in slight limitation of
physical activity: ey are comfortable at rest. Ordinary physical
activity results in fatigue, palpitations, dyspnea, or anginal pain.
III. Patients with cardiac disease resulting in marked limitation of
physical activity: ey are comfortable at rest. Less than ordinary
activity causes fatigue, palpitations, dyspnea, or anginal pain.
IV. Patients with cardiac disease resulting in inability to carry on
any physical activity without discomfort: Symptoms of heart
failure or the anginal syndrome may be present even at rest. If
any physical activity is undertaken, discomfort increases.
Pulmonary arterial
hypertension
Pulmonary arterial hypertension is defined as:
• Mean pulmonary artery pressure by right heart catheterization
≥20 mm Hg and a pulmonary capillary wedge pressure ≤15
mm Hg ; and pulmonary vascular resistance ≥2 Wood units.
Pulmonary arterial hypertension risk categories are measured
using the 3-strata risk score calculator.
Shunt
(hemodynamically
significant shunt)
An intracardiac shunt is considered hemodynamically significant
if there is evidence of chamber enlargement distal to the shunt
and/or evidence of sustained Qp:Qs ≥1.5.
An intracardiac shunt not meeting these criteria would be
described as small or trivial.
Modified with permission from Stout et al. Copyright © 2018 American Heart Association, Inc.
and American College of Cardiolog y Foundation.
ACHD indicates adult congenital heart disease; AP, anatomic and physiological; ICD,
implantable cardioverter-defibrillator; NYHA, New York Heart Association; and Qp:Qs,
pulmonary-to-systemic blood flow ratio.
(cont'd)
3.1. Care Access and Delivery in the ACHD Population
COR LOE
Recommendation
1 B-NR
1. ACHD programs and clinicians who care for adults
with congenital heart disease should follow policies and
procedures that reduce barriers, reduce attrition, and improve
access to lifelong ACHD care.
