Version May 2024
| Class | NYHA functional classification[1] | Canadian Cardiovascular Society functional classification[2] | Specific activity scale[3] |
| I | Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. | Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous or rapid prolonged exertion at work or recreation. | Patients can perform to completion any activity requiring ≥7 metabolic equivalents (ie, can carry 24 lb up 8 steps; do outdoor work [shovel snow, spade soil]; do recreational activities [skiing, basketball, squash, handball, jog/walk 5 mph]). |
| 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. | Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair-climbing after meals, in cold, in wind, or when under emotional stress, or only during the few hours after awakening. Walking more than 2 blocks on the level and climbing more than 1 flight of ordinary stairs at a normal pace and in normal conditions. | Patients can perform to completion any activity requiring ≥5 metabolic equivalents (eg, have sexual intercourse without stopping, garden, rake, weed, roller skate, dance foxtrot, walk at 4 mph on level ground) but cannot and do not perform to completion activities requiring ≥7 metabolic equivalents. |
| III | Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less-than-ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain. | Marked limitation of ordinary physical activity. Walking 1 to 2 blocks on the level and climbing 1 flight in normal conditions. | Patients can perform to completion any activity requiring ≥2 metabolic equivalents (eg, shower without stopping, strip and make bed, clean windows, walk 2.5 mph, bowl, play golf, dress without stopping) but cannot and do not perform to completion any activities requiring >5 metabolic equivalents. |
| IV | Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased. | Inability to carry on any physical activity without discomfort. Anginal syndrome may be present at rest. | Patients cannot or do not perform to completion activities requiring >2 metabolic equivalents. Cannot carry out activities listed above (specific activity scale III). |
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