NYHA Classification
Class I: No limitation. Ordinary activity causes no symptoms.
Class II: Slight limitation. Comfortable at rest, ordinary activity causes fatigue.
Class III: Marked limitation. Less than ordinary activity causes symptoms.
Class IV: Unable to carry out any activity without discomfort. Symptoms at rest.
HFrEF Management (2022 ESC)
Four pillars:
- ARNI (sacubitril/valsartan) or ACE-I/ARB
- Beta-blocker (bisoprolol, carvedilol, metoprolol succinate)
- MRA (spironolactone, eplerenone)
- SGLT2 inhibitor (dapagliflozin, empagliflozin)
Add: Diuretics (symptom relief), Ivabradine (if HR >70 on max beta-blocker).
Revision history
- 20 September 2026 — Initial publication
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