What Are the Four Stages of Congestive Heart Failure?

The four stages of heart failure are classified by the letters A, B, C, and D. "A" is the least severe stage with no symptoms, and the scale progresses to "D," the most severe, requiring aggressive medical treatment.

Heart failure is a condition in which the heart does not pump enough blood and oxygen to the organs and tissues of the body. As a result, the organs in the body do not get the blood they need and fluids back up in the body.

Heart failure does not mean the heart has stopped beating; it simply means the heart has failed to work as it should.

Early on, patients with heart failure may have no symptoms. As the condition progresses and worsens, symptoms and signs may include the following:

• Tiredness
• Weakness
• Lightheadedness
• Dizziness
• Trouble breathing/shortness of breath
  • This may lead to decreased activity
  • Difficulty breathing when lying down, which may cause people to need pillows to prop them up at night to sleep
• Fast heartbeat, even at rest
• Swelling in the feet, ankles, and legs
• Swelling in the abdomen
• Weight gain

Heart failure may be caused by other conditions that weaken the heart:

• Heart attack
• Coronary artery disease, the most common type of heart disease
• Congenital heart disease
• Faulty heart valves
• High blood pressure (hypertension)
• Inflammation or damage to the heart muscle (myocarditis)

Some medical conditions can increase the risk of developing heart failure:

• Diabetes
• Obesity

Unhealthy lifestyle and behaviors can also increase the risk of developing heart failure, especially in people with the medical conditions listed above. The following behaviors can contribute to developing heart failure:

• Smoking
• A diet high in fat, cholesterol, and sodium
• Sedentary lifestyle
• Excessive alcohol intake

Heart failure is diagnosed with a physical exam and tests that may include:

• Electrocardiogram (ECG) to measure the electrical activity in the heart
• Brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) blood tests
  • BNP or NT-proBNP level is high in people with heart failure
• Chest X-ray to check for fluid in the lungs and to see the general shape of the heart and large blood vessels in the chest
• Echocardiogram ("echo") uses sound waves to create a picture of the heart as it beats and can show how well the heart is pumping, and how well the heart valves are working
• Stress test to see if the heart gets enough blood when under stress
  • Patients may run or walk on a treadmill with ECG or other heart tests
  • Medicine to stress the heart may be administered for patients unable to walk or run
• Cardiac catheterization ("cardiac cath") involves a thin tube inserted into a blood vessel in the leg or arm that is threaded up to the heart to take measurements. This can show if any arteries in the heart are narrowed or blocked (coronary angiography).

Treatment for heart failure usually includes lifestyle modifications and medications to control the condition. In severe cases, surgery may be indicated.

• Medications used to treat heart failure include:
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (also called ARBs or angiotensin-2 receptor antagonists)
• Angiotensin-receptor neprilysin inhibitors (ARNIs)
• If channel blockers
• Beta-blockers (also called beta-adrenergic blocking agents)
• Aldosterone antagonists
• Hydralazine and isosorbide dinitrate (specifically of benefit for African-Americans with heart failure)
• Diuretics (water pills)
• Other medications might be prescribed depending on a patient's other health problems, such as:
  • Anticoagulants (blood thinners)
  • Cholesterol-lowering drugs (statins)
  • Digoxin

Lifestyle modifications used to treat and manage heart failure include:

• Not smoking
• Losing weight if you are overweight
• Limiting fluid intake if recommended
• Limiting or avoiding alcohol
• Limiting or avoiding caffeine
• Consuming a heart-healthy diet
• Exercising regularly
• Practicing stress reduction techniques such as deep breathing, yoga, and meditation
• Tracking symptoms and reporting them to your doctor
• Keeping blood pressure in check
• Getting adequate sleep
• Joining a support group
• Getting vaccinated for flu and pneumonia

Implantable devices used to treat heart failure include the following:

• Implantable cardioverter defibrillator (ICD)
• Cardiac resynchronization therapy (CRT)
• Left ventricular assist device (LVAD)

Surgery used to treat heart failure includes the following:

• Heart transplantation
• Percutaneous coronary intervention (PCI, also referred to as angioplasty)
• Valve replacement

The American Heart Association and the American College of Cardiology classify heart failure in four stages, according to the degree of symptoms or functional limits.

• Stage A
  • Presence of heart failure risk factors but no heart disease and no symptoms
• Stage B
  • Heart disease is present but there are no symptoms (structural changes in heart before symptoms occur)
• Stage C
  • Structural heart disease is present AND symptoms have occurred
• Stage D
  • Presence of advanced heart disease with continued heart failure symptoms requiring aggressive medical therapy

The life expectancy for congestive heart failure depends on the cause of the heart failure, its severity, and other underlying medical conditions.

In general, about half of all people diagnosed with congestive heart failure will survive five years. About 30% will survive 10 years.

In patients who receive a heart transplant, about 21% of patients are alive 20 years later.