NYHA Functional Classification
Classifies heart failure severity by functional limitation to guide treatment escalation and prognostication
Also written as: NYHA, NYHA class.
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Scoring type
- classification
- Care settings
- Emergency department, Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The NYHA Functional Classification can activate when the transcript or pasted chart context documents any of these:
- Heart failure assessment
- CHF functional status evaluation
- Dyspnea in known HF patient
- HF treatment optimization
- Heart failure prognosis discussion
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I50.
Note-type scope: it activates on notes whose subject resolves to cardiology, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
3 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Explicitly documented NYHA functional class (I–IV) | history |
| Functional classification of heart-failure symptom burden. Asked as: “What is the patient's current NYHA functional class?” |
| Degree of physical activity limitation from cardiac symptoms (dyspnea, fatigue, angina, palpitations) | symptom | ||
| Level of exertion that provokes symptoms (ordinary activity, less than ordinary, at rest) | history |
Scoring
Class I: No limitation — ordinary physical activity does not cause symptoms. Class II: Slight limitation — comfortable at rest, ordinary activity causes symptoms. Class III: Marked limitation — comfortable at rest, less than ordinary activity causes symptoms. Class IV: Unable to carry on any activity without discomfort — symptoms at rest.
Class from symptom limitation Degree of physical activity limitation from cardiac symptoms (dyspnea, fatigue, angina, palpitations) and exertional capacity Level of exertion that provokes symptoms (ordinary activity, less than ordinary, at rest) (I=no limitation, II=slight, III=marked, IV=symptoms at rest)
Interpretation
Class I: Asymptomatic HF, optimize medical therapy. Class II: Mild symptoms, ensure GDMT optimization (ACEi/ARB/ARNI, beta-blocker, MRA, SGLT2i). Class III: Significant symptoms, consider advanced therapies (CRT, ICD). Class IV: Refractory HF, evaluate for inotropes, mechanical support, transplant, or palliative care. 1-year mortality: Class I ~5%, Class II ~10%, Class III ~20%, Class IV ~50%.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: AHA/NYHA.
- The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great VesselsNYHA Functional Classification · 1994 · NYHA · Consensus · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the NYHA Functional Classification at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a NYHA Functional Classification value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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