Heart Failure In Stages
The literature reveals three major heart failure classification systems used to guide treatment plans. The New York Heart Association classifies patient status by the type and level of functional impairment related to HF. The American College of Cardiology and the American Heart Association Stages of Heart Failure focus on the structural cardiovascular changes responsible for symptoms. The European Society of Cardiology classifies HF in terms of the hearts ability to function as a pump.
The New York Heart Association
- Class I No symptoms but predisposition to developing HF
- Class II Can perform activities of daily living but fatigued when doing so
- Class III Have difficulty performing daily living activities
- Class IV Short of breath even at rest
American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF).
- Stage A - Patient at high risk for HF without structural heart disease or symptoms of HF
- Stage B - Patient has structural heart disease without symptoms of HF
- Stage C - Patient has structural heart disease with prior of current symptoms of HF
- Stage D - Patient has refractory HF requiring specialized intervention
European Society of Cardiology (ESC)
The ESC promotes 1) preventing heart failure in patients at risk, 2) identifying and treating people with early signs of abnormal heart muscle remodelling because once heart failure is established it is rarely reversed and 3) correctly diagnosing the type of heart failure because currently no therapies have been shown to extend life for those patients with HF with preserved ejection fraction (HFpEF) (Ponikowski, 2014).
The ESC staging system identifies three types of heart failure. Each of the three heart failure diagnoses listed below will be covered more thoroughly in Module-2.
- HF with preserved ejection fraction (HFpEF)
- HF with mid-range ejection fraction (HFmEF)
- HF with reduced ejection fraction (HFrEF)
Ponikowski P., Anker S., AlHabib K., Cowie M., Force T., HU S., Jaarsma T., Krum H., Rastogi V., et al. (2014) Heart failure: preventing disease and death worldwide. ESC Heart Failure 1, 4–25. Published online 29 August 2014. Accessed online 10/29/2016.