How heart failure is graded

Assessing your heart failure is important for when you have your appointment with your healthcare professional as the two scales below are based on how you feel and a measure of your symptoms. The doctor or nurse will want to know how you have been feeling since your last appointment and you can tell them where you fit into these two scales. You may find, for instance, you are NYHA Class II four days a week and feel more like NYHA Class III the other three days a week. The scales can also help you on a day-to-day basis in your everyday management of your condition and you can then relate this to your doctor or nurse at your next appointment. Your doctor will then work with you to grade your heart failure when you are first diagnosed and again at later visits. There are two systems used for grading heart failure and it is likely that your doctor will use a combination of both.

New York Heart Association (NYHA) classes

This system is used to classify how severe your condition is based on your symptoms.

Class I (no symptoms) You have no symptoms and can perform daily activities without feeling tired or short of breath.
Class II (mild symptoms) You are comfortable when resting, but moderate activity makes you tired or short of breath.
Class III (moderate symptoms) You are comfortable when resting, but even limited physical activity makes you tired or short of breath.
Class IV (severe symptoms) You are unable to do any physical activity without discomfort and experience some symptoms at rest.

American Heart Association/American College of Cardiology stages

This system accepts that heart failure can be present even before you get symptoms.

Stage A You don’t have heart failure.
But you are at high risk due to having another medical condition that can lead to heart failure, such as high blood pressure, diabetes, obesity or coronary artery disease.
Stage B Your heart has been damaged by your other medical condition(s) or other factors, but you don’t have any symptoms yet.
Stage C Your heart is damaged and you are experiencing heart failure symptoms.
Stage D You have severe heart failure that requires specialised care, despite receiving treatment.

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ESC Guidelines for Heart Failure

What patients need to know

This guide for patients from the European Society of Cardiology aims to provide an overview of the latest evidence-based recommendations for the diagnosis and treatment of heart failure.

In particular, it should help patients to understand the:

  • main types of heart failure
  • medicines used to treat heart failure
  • devices that may be appropriate
  • importance of rehabilitation
  • management by a multidisciplinary team
  • importance of self-care in managing your own condition

Learn more


A series of 9 simple, captivating animations explaining heart failure and its treatment.

These narrated animations explain how a healthy heart works, what happens to it in heart failure and how various treatments work to improve your health.


In this section you can watch, listen or read interviews with other people with heart failure and their caregivers.


and share your own views and experiences with other patients, families and caregivers. is a European Society of Cardiology website

The website was developed under the direction of the Heart Failure Association of the European Society of Cardiology (ESC). The ESC is a world leader in the discovery and dissemination of best practices in cardiovascular medicine. Our members and decision-makers are healthcare professionals who volunteer their time and expertise to represent professionals in the field of cardiology in Europe and beyond.

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