Author + information
- Martin Dolgin, MD* ()
- ↵*Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY 10016
The recent study by Mehra et al. (1) in the Journalcontains the following sentence: “The severity of CHF was categorized by New York Heart Association (NYHA) functional class criteria, etc.” (1). It exemplifies a common practice in the current professional literature dealing with heart failure to use the NYHA functional classification as a system for grading the severity of heart failure. Such statements are not correct. The NYHA functional classification has never been proposed as a method for grading the severity of heart failure. This classification (2) is an imprecise, nonquantified exercise tolerance test in which the exercise is listed as “ordinary physical activity” (not further defined) and the end points are one or more of the following symptoms: undue fatigue, palpitation, shortness of breath, and anginal syndrome. Thus, patients with heart disease who are in class 1 are capable of performing “ordinary physical activity” without experiencing any of the listed symptoms; those in class 2 do experience one or more of the symptoms during “ordinary physical activity”; those in class 3 experience one or more of these symptoms when performing exercise that is less strenuous than “ordinary physical activity”; those in class 4 experience one or more of these symptoms at rest. The four-symptom end points listed above are common in patients with heart disease, but they are not specific for heart failure. They are not synonymous with heart failure, and in none of the official publications of the NYHA describing the functional classification in its present form, initially published in 1943 (3), are the words “heart failure” used. The functional classification provides a clinically useful, although crude, estimate of a patient's exercise capacity. It is a conceptual and linguistic distortion to transform the simple exercise algorithm into the complex and multifaceted concept of heart failure.
- American College of Cardiology Foundation
- Mehra M.R.,
- Uber P.A.,
- Par M.H.,
- et al.
- Dolgin M.
- Criteria Committee of the New York Heart Association