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AMA Manual of Style (10th edition ed.) : A Guide for Authors and Editors

AMA Manual of Style Committee

Publisher:
Oxford University Press
Print Publication Date:
Mar 2007
Print ISBN-13:
9780195176339
Published to AMA Manual of Style:
Apr 2009
DOI:
10.1093/jama/9780195176339.001.0001
© American Medical Association
Contents

Heart Disease Classifications

Chapter:
Nomenclature
Author(s):

Harriet S. Meyer

15.3.10 Heart Disease Classifications

Several classifications pertaining to heart disease are in use:

Classification

Applies to

Classes

Example

Braunwald12

Unstable angina

I-III

Braunwald class I

IA-IIIC

Braunwald class IIIB

Canadian Cardiovascular Society (CCS)13,14

Exertional angina

I-IV

CCS class II

Forrester15-17

Cardiac function after myocardial infarction

I-IV

Forrester class I

Killip17-19

Cardiac status after myocardial infarction

I-IV

Killip class I heart failure

New York

Cardiac disease and functional capacity

I-IV

NYHA class I

Heart

Association (NYHA)20

The classes are assessed in various ways, for instance, by physical examination (Killip), hemodynamic measurement (Forrester), and patient history (NYHA). The detailed meanings of each class are beyond the scope of this book, but several style points may be noted:

  • ▪ Severity increases from lower to higher numbers and letters.

  • ▪ There is no automatic correspondence between classes (eg, Killip class I is not equivalent to NYHA class I).

  • ▪ The numerals are designators and are not quantitative or semiquantitative. Therefore, roman numerals are appropriate.

    Avoid:

    Forrester class >2

    Acceptable equivalents:

    Forrester class above II

    class greater than Forrester II

    Forrester classes III and IV

  • ▪ Authors should describe their classification criteria, for instance:

    Killip class on admission was determined as the following: patients in class I were free of rales and a third heart sound; patients in class II had rales up to 50% of each lung field regardless of the presence of the third heart sound…(adapted from Neskovic et al21).

    We suggest that cases of unstable angina class IIIB now be subdivided into troponin-positive and troponin-negative subgroups … (adapted from Hamm and Braunwald22[p120]).