American Society of Anesthesiologists ( ASA) Physical Status and Heart Disease Classifications

A client with either an ASA Classification of Physical Status of I (P1) or II (P2), or Classification of Heart Disease I, II, or III is considered suitable for ASC care. Clients with an ASA Classification of Physical Status of III (P3), IV (P4), or V (P5) or Classification of Heart Disease IV should be considered for inpatient status.

 The description of ASA classes is as follows:

 • Class I. A normal, healthy patient, without organic, physiologic, or psychiatric disturbance.
Example: Healthy patient with good exercise tolerance.


• Class II. A patient with mild systemic disease, controlled medical conditions without significant
systemic effects. Example: Controlled hypertension, controlled diabetes mellitus without system effects, cigarette smoking without evidence of Chronic Obstructive Pulmonary Disease (COPD), anemia, mild obesity, age less than one or greater than 70 years, pregnancy.


• Class III. A patient exhibiting severe systemic disturbance that may or may not be associated with the surgical complaint and that seriously interferes with the patient’s activities.

 Example: Healthy patient with good exercise tolerance.


• Class IV. A patient exhibiting extreme systemic disturbance that may or may not be associated with the surgical complaint that interferes with the patient’s regular activities, and that has already become lifethreatening.

Example: Organic heart disease with marked signs of cardiac insufficiency present (e.g.,
cardiac decompensation); persistent anginal syndrome,  or active myocarditis; advanced degrees of pulmonary,hepatic, renal, or endocrine insufficiency present.


• Class V. The rare person who is moribund (in a dying state) before operation, whose preoperative condition is such that he or she is expected to die within 24 hours even though not subjected to the additional strain of the operation.

 Example: Burst abdominal aneurysm with profound shock; major cerebral trauma with rapidly increasing intracranial pressure; massive embolus.

Heart Disease classifications are described below:

• Class I. No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.

• Class II. Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity
results in fatigue, palpitation, dyspnea, or anginal pain.

• Class III. Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity
causes fatigue, palpitation, dyspnea, or anginal pain.

• Class IV. Unable to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency, or of the anginal syndrome, may be present even at rest. If any physical activity is undertaken, discomfort occurs.