Home Cardiovascular Disease Heart Failure - Stages & Classification

Heart Failure - Stages & Classification

What are the different stages of heart failure?

The course of heart failure varies from person to person and depends on individual factors, including the cause of heart failure and the severity of symptoms. For many people, heart failure is a long-term, progressive deterioration of the heart’s pumping ability that starts slowly and gets worse over time. When symptoms start, you may feel tired and short of breath after performing tasks that you used to do with ease. As heart failure progresses, the symptoms can get worse. For other people, heart function may improve with current treatments, and they can recover fully or have long periods of stability.

Doctors use two different measurement systems to classify:

  1. your stage in the progression of heart failure (AHA/ACC)
  2. how much your symptoms are limiting your functional capacity, or ability to perform basic physical tasks (NYHA)

The AHA/ACC Stages of Heart Failure

The American Heart Association (AHA)/American College of Cardiology (ACC) staging system for heart failure focuses on the progression and worsening of the condition over time. The AHA/ACC staging system moves forward—from one stage to the next—based on the progression of the disease. It helps doctors identify people who are at high risk for heart failure but don’t have the condition yet ( Stage A), those with heart damage but no symptoms of heart failure ( Stage B), and those with heart damage and with symptoms of heart failure (Stages C and D). The AHA/ACC staging system helps doctors prevent heart failure in those at risk and complements the New York Heart Association (NYHA) classification system, which gauges the severity of symptoms in people who are at stages C and D of the AHA/ACC system.

AHA/ACC Heart Failure Stages
Stage Description
A People at high risk for developing heart failure but who do not have heart failure or damage to the heart
B People with damage to the heart but who have never had symptoms of heart failure; for example, those who have had heart attack
C People with heart failure symptoms caused by damage to the heart, including shortness of breath, tiredness, inability to exercise
D People who have advanced heart failure and severe symptoms difficult to manage with standard treatment

The New York Heart Association (NYHA) Classification System

The NYHA classification system is used to classify symptoms of heart disease, including heart failure. Symptoms are graded based on how much they limit your functional capacity (your ability to perform basic physical tasks). Unlike the AHA/ACC staging system, the NYHA class often can shift from one level to another; for example, if you respond well to treatment and your symptoms improve, your NYHA class can go down. If you don’t respond well and your symptoms continue to worsen, your NYHA class can go up.

NYHA Heart Failure Classification
Class Description
1 (Mild) No limitation of physical activity - ordinary physical activity doesn’t cause tiredness, heart palpitations, or shortness of breath
2 (Mild) Slight limitation of physical activity – comfortable at rest, but ordinary physical activity results in tiredness, heart palpitations, or shortness of breath
3 (Moderate) Marked or noticeable limitations of physical activity – comfortable at rest, but less than ordinary physical activity causes tiredness, heart palpitations, or shortness of breath
4 (Severe) Severe limitation of physical activity – unable to carry out any physical activity without discomfort. Symptoms also present at rest. If any physical activity is undertaken, discomfort increases.

Next: Causes of Heart Failure and Who is at Risk

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