The Four Stages of Heart Failure
Last updated: September 2023
There are four stages of heart failure. The stages range from being at risk of heart failure to having advanced heart failure. These stages were created by the American Heart Association and the American College of Cardiology and were given letter titles A, B, C, and D. Each stage has different recommended treatments depending on a multitude of factors.1
Stage A is known as “pre heart failure.” In this stage, the person doesn’t actually have full-blown heart failure but has a higher risk of developing heart failure. These risk factors include having high blood pressure (hypertension), a family history of cardiomyopathy, diabetes, coronary artery disease (CAD), excessive alcohol abuse, and rheumatic fever to name a few. The heart structure is generally healthy.1
Treatment in stage A mostly involves preventative maintenance. Maintaining a healthy diet, regular exercise, and not smoking are a few things to help prevent heart failure from progressing. If you have high blood pressure or diabetes, staying compliant with medications can help keep heart failure at bay.1
Like stage A, this stage is also often referred to as “pre heart failure.” What's different about stage B is that the heart has been diagnosed with some structural problems such as reduced pumping efficiency. In this stage, the person will also not have any of the typical heart failure symptoms as in the more advanced stages. The majority of people in stage B heart failure have an ejection fraction of 40% or less.1
Treatment for stage B includes the same things as in stage A with more added to the regimen. Certain medications such as beta-blockers are often started at this stage. Depending on the severity, the need for certain surgical procedures to correct coronary artery blockage or replace a heart valve may also performed.1
Stage C is where heart failure has begun to cause symptoms that result from the weakening of the left ventricle. This is also the stage where symptoms such as fatigue and shortness of breath are a common occurrence. Swelling in the extremities, specifically the legs and feet, may also occur during stage C.1
The treatment for stage C includes both things mentioned above in stages A and B as well as adding in a few other options. Diuretics (water pills) can help remove excess fluid that can be building up as a result of the weakening of the heart. Restricting salt and fluid intake if recommended by your doctor can also help reduce symptoms. Monitor weight and watch for signs of fluid buildup.1
Stage D is the most severe of the heart failure stages. In this stage, the heart has advanced structural disease and may not respond to treatment. People in stage D will have significant symptoms even at rest which can cause severe limitations.1
Treatment options are limited in this stage and include continuous infusion of medicine via IV, heart transplant, ventricular assist devices, and palliative/hospice care. Generally, when a person is in stage D heart failure they are unable to be discharged from the hospital due to the severity.1
If your doctor has diagnosed you with heart failure or suspected heart failure, discuss which stage they think you're in and what treatment options they recommend. As always, be sure to talk with your doctor before making any kind of diet modifications that could affect your heart.
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