Utility of the New York heart association functional classification compared to other measures: A systematic review

• NYHA-FC has the potential to be a more objective measure of functional class. • NYHA-FC is predictive of functional limitations in patients with HF. • The reproducibility of assigning NYHA-FC could be improved. • Predictive ability in patients with HFpEF is limited when using NYHA-FC. . This systematic review comprised of an assessment of the relevant literature for measures that were most similar to the New York Heart Association Functional Classification. Additionally, we assessed whether those measures compared in accuracy with the New York Heart Association Functional Classification when assigning the functional class of patients with heart failure. The review included seven articles that met the inclusion and exclusion criteria. Our findings were that New York Heart Association Functional Classification was predictive of functional limitations in patients with heart failure with reduced ejection fraction when compared to other measures. However, there was limited evidence to support the predictive ability of New York Heart Association Functional Classification in patients with heart failure with preserved ejection fraction. A more objective way to improve accuracy of New York Heart Association Functional Classification could be to assign metabolic equivalent levels to each functional class. For future directions, a clear objective definition of functional class that is in alignment with the associated symptoms is needed to ensure consistent assignment. In addition, further testing of the New York Heart Association Functional Classification in patients with heart failure with preserved ejection fraction with reproducibility is warranted. .