Current concept in the diagnosis, treatment and rehabilitation of patients with congestive heart failure

Table 1 Comparison of American College of Cardiology/American Heart Association Stages of HF and New York Heart Association Functional Classifications (data from[2])

	ACC/AHA Stages of HF		NYHA Functional Classification	Restriction of physical activity
A	At high risk for HF but without structural heart disease or symptoms of HF (e.g., diabetes, arterial hypertension)		/	/
B	Structural heart disease but without symptoms of HF	I	Regular physical activity does not cause dyspnea and fatigue – asymptomatic	No limitation of physical activity
C	Structural heart disease with prior or current symptoms of HF	I	Regular physical activity does not cause dyspnea and fatigue – asymptomatic	No limitation of physical activity
		II	Moderate physical activity results in milder dyspnea and fatigue	Slight limitation of physical activity
		III	No difficulty at rest; minimal physical activity leads to exhaustion, dyspnea, and fatigue	Marked limitation of physical activity
		IV	Symptomatic at rest	Unable to carry on any physical activity without symptoms of HF
D	Refractory HF requiring specialized interventions	IV	Symptomatic at rest	Unable to carry on any physical activity without symptoms of HF

ACC/AHA: American College of Cardiology/American Heart Association; HF: Heart failure; NYHA: New York Heart Association.

Table 2 Contraindications for exercise training and screening for increased risk for exercise training (data from[110])

Contraindications to exercise training	Increased risk for exercise training
Progressive worsening of exercise tolerance or dyspnea at rest over previous 3–5 d	> 1.8 kg increase in body mass over the previous 1-3 d
Significant ischemia during low-intensity exercise (< 2 METs, < 50 W)	Concurrent, continuous, or intermittent dobutamine therapy
Uncontrolled diabetes	Decrease in systolic blood pressure with exercise
Recent embolism	NYHA functional class IV
Thrombophlebitis	Complex ventricular arrhythmia at rest or appearing with exertion
	Supine resting heart rate > 100 b.p.m.
	Pre-existing co-morbidities limiting exercise tolerance

NYHA: New York Heart Association.