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Understanding Heart Failure Classifications

What is the “Stages of Heart Failure” system?

Your health care provider may use another classification system to show how your heart failure is progressing. This is called the “Stages of Heart Failure” system.¹

The American Heart Association and American College of Cardiology developed this system. It uses a scale with letters from A to D to represent four stages. This system is not based on how you feel. Your heart failure stage is based on your risk of developing heart failure. It includes how well your heart is functioning now, if there is any damage to your heart, and your symptoms.

Stage A: You do not have heart failure now, but are at high risk.

Stage B: You do not have heart failure symptoms yet, but your heart has been damaged by disease or other factors.

Stage C: Your heart has been damaged in some way and you have had heart failure symptoms.

Stage D: You have severe heart failure symptoms and require specialized therapies.

If you do not already have heart failure, this system stresses that you can delay or even prevent it. The key is to know your risk factors and take steps to get them under control.

^{1. Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult—summary article. J Am Coll Cardiol. 2005;46:1116–1143.}

If you have heart failure, you may wonder what your health care provider means when he or she describes your heart failure as Class I, II, III, or IV. In this article, we will look at why heart failure classes are important and what the terms mean.

Your Heart and Your Symptoms

Heart failure does not mean that your heart has stopped working. It means that your heart isn’t as strong as it should be. Some people with heart failure do not have symptoms. But many do. Common symptoms of heart failure include feeling tired, shortness of breath, swollen ankles and weight gain. It can eventually lead to death.

If you have heart failure, it is important to tell your health care provider what you feel and how badly you feel. This helps decide the treatment that will be best for you.

New York Heart Association (NYHA) Classification

The NYHA classification provides a simple way for your health care provider to label your heart failure symptoms. Your health care provider will place your heart failure into one of four categories. If you feel pretty good most of the time, you may be Class I. If you feel badly most of the time, you may be Class IV.

Class I (the mildest form): You can perform everyday activities and not feel out of breath or tired.

Class II: Everyday activities make you feel slightly tired and out of breath.

Class III: Even minor activity causes you to feel tired and out of breath.

Class IV (the most severe): You’re tired and short of breath even at rest.

Your NYHA classification may change as your symptoms change.

In most cases, heart failure cannot be cured. However, many treatment options available today are effective. Your NYHA classification will help you and your health care provider talk about which treatment options may be right for you.

Figure: Enlarged Heart

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