New stage-graduation is supplementing the NYHA-classification.

Patients with congestive heart failure now are classified according to structural changes

After congestive heart failure is diagnosed, an exact classification should be undertaken. The new US guidelines (stages A to D), which are based on structural changes, instead of clinical symptoms, have been established.

In contrast to the NYHA-classification, where patients can change within classes that are higher or lower, in these new guidelines the patient sticks to one class or turns to a higher class. In order to subsume patients to a certain class, examinations that are beyond patient history and physical examination, are necessary. For example the echocardiographic finding of a contraction disorder (hypo-, akinesia) of the ventricular wall can diagnose a status after myocardial infarction or valve disease. Also the systolic ejection fraction can be quantified, and it may be mildly, moderately or highly reduced. Additionally the assumption of congestive heart failure requires at least one echocardiography-procedure. The proof of a reduced systolic left-ventricular ejection fraction is important, since this finding is necessary in order to submit a sufficient medical treatment.