Cardiac Status Grading Criteria
As currently used in MCC-8631 and others:
New York Heart Association Classification of Heart Failure
Class I
No symptoms. Ordinary physical activity such as walking and climbing stairs does
not cause fatigue or dyspnea.
Class II
Symptoms with ordinary physical activity. Walking or climbing stairs rapidly, walking
uphill, walking or stair climbing after meals, in cold weather, in wind or when under
emotional stress causes undue fatigue or dyspnea.
Class
III
Symptoms with less than ordinary physical activity. Walking one to two blocks on
the level and climbing more than one flight of stairs in normal conditions causes
undue fatigue or dyspnea.
Class
IV
Symptoms at rest. Inability to carry on any physical activity without fatigue or
dyspnea.
Taken directly from the reference:
NYHA Functional Capacity Assessment of Cardiac Status (Dolgin et al., 1994)
Class
Description
I
Patients with cardiac disease but without resulting 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. They
are comfortable at rest. Ordinary physical activity results in fatigue, palpitation,
dyspnea, or anginal pain.
III
Patients with marked limitation of physical activity. They are comfortable at rest.
Less than ordinary activity causes fatigue, palpitation, 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 of the anginal syndrome may be
present even at rest. If any physical activity is undertaken, discomfort is increased.
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NYHA Objective Assessment of Cardiac Status (Dolgin et al., 1994)
Grade
Description
A
No objective evidence of cardiovascular disease.
B
Objective evidence of minimal cardiovascular disease.
C
Objective evidence of moderately severe cardiovascular disease.
D
Objective evidence of severe cardiovascular disease.
Dolgin, M., Fox, A.C., Gorlin, R., and Levin, R.I. (1994). Nomenclature and Criteria for Diagnosis
of Diseases of the Heart and Great Vessels, 9 edn (Boston, Little, Brown and Company).
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