Stages of Heart Failure

Doctors describe heart failure in stages and in functional classes. Both help decide treatment and track change.

ACC/AHA stages

• Stage A: at risk, with high blood pressure, diabetes, obesity or a family history, but no heart damage or symptoms yet. The aim is prevention.
• Stage B: structural heart changes, such as a weak heart muscle or past heart attack, without symptoms. Treatment aims to prevent progression.
• Stage C: structural heart disease with current or past symptoms such as breathlessness and fatigue. Most patients on regular medicines are here.
• Stage D: advanced heart failure with severe symptoms despite treatment. Options include specialist care, devices, transplant evaluation and palliative care.

NYHA functional classes (symptoms with activity)

• Class I: no limitation in usual activity.
• Class II: slight limitation. Comfortable at rest, but usual activity causes breathlessness or fatigue.
• Class III: marked limitation. Comfortable only at rest.
• Class IV: symptoms at rest, and any activity worsens them.

Movement between stages

Stages do not usually reverse, but symptoms can improve a lot with treatment. A person in class III may reach class II with good care.

When it worsens

Call 112 or 102 for sudden severe breathlessness, chest pain or fainting. See your doctor promptly for a gain in weight, more swelling or reduced ability to do usual tasks.

Key point

Early treatment, in stages A and B, can prevent heart failure or delay it.

Before your appointment

Bring your list of medicines and supplements, recent test reports such as echocardiogram, ECG and kidney tests, and your daily weight and blood pressure log. Note any breathlessness, swelling, night-time symptoms or reduced activity, and how much salt and fluid you take. Ask about warning signs and when to call 112 or 102.