The Stages and Progression of Heart Failure

Heart failure is a progressive condition and, as it advances, your doctor may describe it as being in a specific stage. Learn what these stages mean.

Learn about heart failure stages and progression

Making Sense of the Classifications, Stages and Progression of Heart Failure

Understanding the different stages, classifications and expected outcomes of heart failure can be quite confusing. Learn about the various stages of heart failure, how doctors determine its severity, and what to expect as your condition progresses. 

What Are the NYHA Classifications of Heart Failure and What Do They Mean?

The New York Heart Association (NYHA) categorizes heart failure into several classifications1 based on the extent of physical activity limitation:

Heart Failure Class 1

No limitation of physical activity. Engaging in ordinary activities does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).

Heart failure class 1 physical activity limitation

Heart Failure Class 2

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activities result in fatigue, palpitation, or dyspnea.

Heart failure class 2 physical activity limitation

Heart Failure Class 3

Marked limitation of physical activity. Comfortable at rest, but less than ordinary activities cause symptoms such as fatigue, palpitation, or dyspnea.

Heart failure class 3 physical activity limitation

Heart Failure Class 4

Unable to carry out any physical activity without discomfort. Symptoms of heart failure are present even at rest, and they increase with any physical activity.

Heart failure class 4 physical activity limitation

What are the ACC/AHA Stages for Heart Failure and What Do They Mean?

The American College of Cardiology/American Heart Association outlines four stages in the development and progression of heart failure2, labeled from A to D.

These stages help in understanding the severity and progression of heart failure, guiding appropriate treatment and management strategies:

 

ACC/AHA StageSymptoms
AIncludes patients who are at high risk for developing heart failure but do not have any symptoms and no structural or functional heart abnormalities have been detected.
BConsists of patients who have structural heart disease that is likely to lead to heart failure, yet they remain without symptoms.
CComprises patients who exhibit current or past symptoms of heart failure due to underlying structural heart disease.
DInvolves patients with advanced structural heart disease who experience significant symptoms of heart failure at rest, even with optimal medical management, and who may require specialized interventions.

What is the Progression of Heart Failure?

In this video, you'll learn about the progression of heart failure. Although heart failure is a serious and progressive condition, early recognition of symptoms may lead to more effective management. The video also covers the treatments and technologies available today that can significantly improve the quality of life for people with heart failure. 

The Symptoms of Heart Failure Progression3

 

A person with lungs

Shortness of Breath

A person with a depleted battery

Decreased Energy

A leg and foot

Swelling of Feet / Ankles / Legs

A person who is dizzy

Lightheadedness
 

A heart with a fast pulse

Faster Heart Rate

A person coughing

Frequent Coughing

A stomach with an exclamation point

Nausea

A scale

Weight Gain

Find a Heart Failure Specialist

Heart failure specialists have additional, extensive training to fully treat patients like you. It's vital to your continued health that you find a clinic specifically dedicated to helping people with heart failure. 

Find a heart failure clinic

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These materials are not intended to replace your doctor's advice or information. For any questions or concerns you may have regarding the medical procedures, devices and/or your personal health, please discuss these with your physicians.

 

References

  1. Classes and States of Heart Failure. American Heart Association website. https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure.  Accessed October 15, 2024.
  2. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Circulation. 2001;104:2996-3007.
  3. Warning signs of heart failure. American Heart Association website. https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure. Accessed October 15, 2024.

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