For physicians, nurses and discharge planners
What is the NYHA class in hospice?
The New York Heart Association (NYHA) classification grades heart failure in four classes by the activity that brings on symptoms, from class I, no limitation, to class IV, symptoms at rest. The Medicare hospice LCD guidance looks for class IV despite optimal treatment, or the documented reasons the patient cannot take it. Beta Hospice in San Bernardino records the class and the symptoms behind it.
Medically reviewed by Oscar Chien, MD, Medical Director, October 26, 2026
On this page (4 sections)
What are the NYHA classes?
The New York Heart Association functional classification grades heart failure by the activity that brings on symptoms.
| Class | Symptoms |
|---|---|
| I | No limitation of physical activity. Ordinary activity does not cause undue fatigue, palpitation or dyspnea |
| II | Slight limitation. Comfortable at rest; ordinary activity causes fatigue, palpitation or dyspnea |
| III | Marked limitation. Comfortable at rest; less than ordinary activity causes symptoms |
| IV | Unable to carry on any physical activity without discomfort. Symptoms at rest; any activity increases discomfort |
American Heart Association, classes of heart failure.
Which NYHA class qualifies for hospice?
Class IV, with symptoms at rest despite optimal treatment with diuretics and vasodilators, or the documented reasons the patient cannot take them, such as hypotension or renal disease. An ejection fraction of 20% or less documents significant heart failure but is not required if not already available. The heart disease criteria list the supporting findings.
Record the class with the symptoms at rest that justify it: dyspnea, orthopnea, angina, fatigue, edema. A class is a judgment about activity tolerance; the chart should show what the patient can and cannot do.
Related guides
All four eligibility scales, the heart disease criteria, the eligibility guidelines by diagnosis and how to refer.
Common questions
Which NYHA class qualifies for hospice?
Class IV, with symptoms at rest despite optimal treatment with diuretics and vasodilators, or the documented reasons the patient cannot take them. The heart disease criteria page has the supporting findings.
Is an ejection fraction required?
No. An ejection fraction of 20% or less documents significant heart failure, but the LCD guidance does not require one if it is not already available.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- October 26, 2026
- Next review
- April 26, 2027
How we write and review this site
Sources
- CMS Medicare Coverage Database: LCD L33393, Hospice: Determining terminal status (opens in a new tab)
- American Heart Association: Classes and stages of heart failure (NYHA functional classification) (opens in a new tab)
These sources support the general information on this page. For one person鈥檚 care and coverage, talk with the hospice team.
Refer a patient or ask a clinical question
Call any time. A nurse can talk through eligibility, timing and logistics for your patient.
Patients have the right to choose their hospice provider.