What Are the Stages of Heart Failure? A Cardiologist Explains

Early treatment may help slow the progression.

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Getting diagnosed with heart failure may be scary, but there’s good news if you get diagnosed early. Treatment can help slow the progression of heart failure to more advanced stages. That means your symptoms may remain mild—if you even have symptoms at all.

There are many ways to assess the stages of heart failure. These usually fall into two categories:

  • A subjective assessment (based on personal experience) of how the patient feels during physical activity, and how much symptoms are limiting them
  • An objective assessment (based on diagnostic testing) that looks for evidence of changes to the heart

Heart Failure Stages by Symptoms

The subjective form of heart failure stages uses the New York Heart Association Functional Classification model. Based on what a patient reports, they fit in one of four stages:

  • Stage I: You can exercise normally without experiencing heart failure symptoms.
  • Stage II: You don’t have heart failure symptoms at rest, but some symptoms slightly limit your physical activity. Symptoms include fatigue and shortness of breath.
  • Stage III: Heart failure symptoms noticeably limit your physical activity (but you still are asymptomatic at rest). You may experience shortness of breath and fatigue with light activity, like climbing stairs.
  • Stage IV: You have symptoms even when you’re resting, and they worsen with any amount of exercise or activity.

The Objective Assessment

The model commonly used for objectively assessing heart failure comes from the American College of Cardiology (ACC) and the American Heart Association (AHA). This model uses tests like electrocardiograms, blood tests, and echocardiograms. It also considers evidence of pulmonary hypertension, enlargement of the ventricles, ankle swelling, and more. Based on diagnostic criteria, a patient fits in one of four classes:

  • Class A: You are at risk of heart failure. However, doctors do not see any structural changes to the heart. You also are not having symptoms and can exercise normally. You can typically manage this with lifestyle changes.
  • Class B: You have some structural evidence of heart failure. You may have no or mild symptoms during physical activity. You may need medications to manage your condition.
  • Class C: You have moderate structural evidence of heart failure in tests, and you are having symptoms during any activity, even light activity. Along with lifestyle changes and medications, you may be eligible for a pacemaker or other implanted device.
  • Class D: You have evidence of severe structural heart failure in tests, and you have very limiting symptoms, even at rest. You may be in need of surgery, heart transplant, implanted devices, or end-of-life care.

Protecting Your Heart Health

The important thing to understand is that severe heart failure is not necessarily inevitable. Committing to healthy habits and sticking to your medications as prescribed may save you from severe illness. By following your prescribed treatment regimen, you may be able to continue living a relatively normal life with fewer limitations.