Four Stages of Heart Failure

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Congestive heart failure is a heart condition in which the heart is unable to pump enough blood to meet the demands of the body. It is a progressive disorder caused by cumulative damage to the heart from various types of cardiovascular diseases. The American Heart Association and the American College of Cardiology developed a staging system in 2001 for heart failure to provide more effective and directed prevention and treatment. The staging system complements the New York Heart Association’s (NYHA) functional classification system.

Stage A

The first stage of heart failure includes Individuals at high risk for developing heart failure with no current heart failure diagnosis or structural disorder of the heart. High-risk individuals have a family history of heart problems, high blood pressure and diabetes, smoke, abuse drugs or alcohol, or have a diagnosis of coronary artery disease. Prevention of heart failure is the focus of therapy in this stage. Lifestyle changes such as increased physical activity, smoking cessation, a healthy diet and medications to lower blood pressure can help in preventing the progression to further stages of heart failure. According to the NYHA functional classification, individuals in this stage have no limitation of physical activity.

Stage B

Individuals who are diagnosed with heart failure but exhibit no symptoms are Stage B candidates. Structural disorders of the heart in this stage include a previous heart attack, dysfunction in the left ventricle, heart fibrosis or valvular heart disease. Medications are generally prescribed at this stage along with close monitoring of blood pressure. Common medications include ACE inhibitors and beta blockers. The NYHA classification system shows a slight limitation in physical activity that results in fatigue or heart palpitations for individuals in this stage.

Stage C

Structural heart disorders and symptoms are present in the third stage of heart failure as well as impaired physical activity. Medications continue with the possible addition of diuretics or aldosterone antagonists, depending on the severity of the symptoms. Rapid onset of fatigue and shortness of breath are common with minimal amounts of physical activity. It is recommended not to consume alcohol, to limit salt intake and to follow strict physical activity guidelines.

Stage D

The last stage of heart failure is often referred to as refractory end-stage heart failure. Despite medication and lifestyle therapies, stage D candidates must consider end-of-life medical care or drastic surgeries, such as a heart transplant or placement of ventricular devices. Physical activity is unable to be performed without discomfort, according to the NYHA classification system. Elderly individuals with several comorbidities represent the majority of individuals in this stage and thus are not good candidates for surgical interventions.