Several approaches could be used to characterize
the signs and symptoms required for the diagnosis of
advanced heart failure. NYHA functional class provides
a simple clinical assessment that may be surprisingly
useful. This categoric system is traditionally
based on the degree of difficulty with shortness of
breath and fatigue that patients have at rest or during
activity. Severe heart failure is characterized by NYHA
functional class III or IV, implying symptoms during
minimal activity or at rest, respectively. The linkage
between NYHA functional class and adverse outcome
is illustrated by results from the CONSENSUS trial.9
More recent data from the FIRST10 and SOLVD8 studies
again confirm the prognostic importance of NYHA
class even when ACE inhibitors are part of background
therapy