What are the four stages of heart failure?

Heart Health

by Timothy Gong, MD, FACC

May 7, 2024

You may have heard about different stages of conditions like cancer. But stages are also important when it comes to another common condition—congestive heart failure.

Many people don’t realize that they may be at risk for heart failure or how common the condition is today. About a million new cases of heart failure are reported each year in the United States—more than breast, prostate and lung cancers combined. And like cancer, when you know the risk factors, signs and stages of heart failure, it gives you the information you need to guide your next steps.

What is heart failure, and what causes it?

Heart failure is a progressive condition where the heart is unable to pump blood efficiently enough to meet the body’s needs. It’s different than a heart attack, which happens when severe blockages in the heart’s arteries stop the flow of blood in the heart. But heart attacks or coronary artery disease can lead to heart failure.

Other factors or conditions that put you at risk for heart failure include:

  • Uncontrolled high blood pressure
  • Uncontrolled diabetes
  • Excessive alcohol
  • Chemotherapy treatments
  • Genetic causes
  • Cardiac amyloidosis, a build up of abnormal proteins in the heart tissue.
  • Sarcoidosis, a condition where small lumps or nodules called granulomas develop in the heart.

Understanding the four stages of heart failure

Heart failure is grouped into stages A, B, C and D. The four stages were created by the American College of Cardiology, American Heart Association and Heart Failure Society of America to classify heart failure and give providers a better sense of where someone is in their heart failure journey.

Stage A

These people are at risk for heart failure, but they don’t have any symptoms of structural or functional heart disease. They may have hypertension, diabetes or a family history of heart failure. This puts them at risk, but they don’t always progress to the next stage.

Stage B

With time, particularly if a person doesn’t get risk factors under control, heart failure can progress. People in stage B do not have current symptoms of heart failure, but they have developed structural heart disease.

Stage C

At this stage, heart failure has progressed to where you now have symptoms. The most common symptoms are shortness of breath and swelling. Other signs could include weight gain or waking in the middle of the night because you can’t breathe.

Stage D

These patients have progressed to end-stage heart failure. Symptoms are so bad that you can’t go about your daily life, and you may end up being hospitalized. If you’re having shortness of breath with basic activities like showering or walking through the grocery store, those are warning signs of advanced heart failure.

Heart failure diagnosis and staging

In the early stages, people don’t have heart failure symptoms, and even when symptoms begin to appear, it can be difficult for people to differentiate the symptoms of heart failure from other conditions. For example, both heart failure patients and heart attack patients could report chest pain, and there are generalized symptoms like fatigue.

That’s why it’s important to visit with a cardiologist if you have heart failure risk factors or symptoms. There are nuanced things your cardiologist can help you figure out, and your doctor can order tests to diagnose and stage heart failure. These non-invasive tests include an EKG to look at the electrical signals of your heart and an echocardiogram, which is an ultrasound of the heart.

An echocardiogram allows your doctor to look at many things, including the squeezing function of your heart, how the heart relaxes and how the valves work. This helps identify and stage both diastolic heart failure—where there’s a problem with the relaxation of the heart—and systolic heart failure—where there’s a problem with the squeezing of the heart.

Living well at every stage of heart failure

Whether you have risk factors for heart failure or are experiencing symptoms, the good news is that you can take steps to care for your heart. Once you know your heart failure stage, your cardiologist can work with you to create a treatment plan.

For people in the early stages of heart failure, it’s really about risk factor management. If you have high blood pressure, diabetes or coronary artery disease, follow your cardiologist’s guidance and keep these risks under control. Even if you have inherited genes or a family history of heart disease, early recognition matters. Then, you can do everything to protect yourself against worsening those risk factors.

People in the later stages of heart failure can also still benefit from lifestyle modifications. Even with a weak heart, people should stay active and keep their strength up so that they can continue to do those activities of daily living. In these stages, you should also be seeing a heart failure specialist to guide your care.

No matter the stage of heart failure, be vigilant and take care of yourself. With prevention and knowledge, you can reduce the chances of your heart failure progressing to a more advanced stage and keep your heart working as it should.

Want to learn more about your heart health? Book an appointment with a cardiologist today.

About the Author

Timothy Gong, MD, FACC, is a cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas and Baylor Scott & White Medical Center – Irving. 

Dr. Gong specializes in the treatment of patients with advanced heart failure, and he is the section physician leader for the Heart Failure, Transplant and Mechanical Support Cardiology Team. His clinical interests include ventricular assist devices and cardiac transplant.

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