5
Table 2. Comparison of ACCF/AHA Stages of HF and NYHA
Functional Classifications
ACCF/AHA Stages of HF NYHA Functional Classification
A At high risk for HF but
without structural heart
disease or symptoms of HF
None
B Structural heart disease but
without signs or symptoms
of HF
I No limitation of physical activity.
Ordinary physical activity does not
cause symptoms of HF.
C Structural heart disease with
prior or current symptoms
of HF
I No limitation of physical activity.
Ordinary physical activity does not
cause symptoms of HF.
II Slight limitation of physical activity.
Comfortable at rest, but ordinary
physical activity results in symptoms
of HF.
III Marked limitation of physical activity.
Comfortable at rest, but less than
ordinary activity causes symptoms
of HF.
IV Unable to carry on any physical
activity without symptoms of HF, or
symptoms of HF at rest.
D Refractory HF requiring
specialized interventions
IV Unable to carry on any physical
activity without symptoms of HF, or
symptoms of HF at rest.
Classifications
Diagnosis
Assessment
Î A thorough history and physical examination should be obtained/
performed in patients presenting with HF to identify cardiac and
noncardiac disorders or behaviors that might cause or accelerate the
development or progression of HF. (I-C)
Î In patients with idiopathic dilated cardiomyopathy (DCM), a
3-generational family history should be obtained to aid in establishing
the diagnosis of familial DCM. (I-C)
Î Volume status and vital signs should be assessed at each patient
encounter. This includes serial assessment of weight, as well as
estimates of jugular venous pressure and the presence of peripheral
edema or orthopnea. (I-B)
Î Validated multivariable risk scores can be useful to estimate
subsequent risk of mortality in ambulatory or hospitalized patients
with HF. (IIa-B)
