What Are The 4 Stages of Congestive Heart Failure?

Congestive heart failure is a chronic condition that affects approximately 6 million Americans. It is the leading cause of hospitalizations in people over the age of 65. Heart failure occurs when the heart muscle cannot pump blood efficiently to the various organs in the body, leading to an accumulation of fluids, mostly in the lungs and legs.

There is no cure for heart failure. Over time, the heart pumps less and less blood, and you move to the next stage of heart failure. Medications and other treatments can slow or prevent progression to the advanced stages of congestive heart failure. Please continue reading to learn more.

What are the types of heart failure?

Systolic heart failure or systolic left ventricular dysfunction in which the left ventricle (left-sided bottom chamber) of the heart is weak and cannot pump blood properly.
Diastolic heart failure or heart failure with preserved ejection fraction in which the left ventricle becomes stiff and does not fill properly with blood.
Right-sided heart failure is when the right ventricle (right-sided bottom chamber) is too weak to pump blood properly to the lungs.
High-output heart failure (rare) in which there is normal heart function but an increased demand by the body that the heart is unable to meet.

What are the causes and risk factors for developing heart failure?

Potential causes of heart failure are coronary heart disease, heart attack, structural heart disease such as valvular heart disease, heart rhythm abnormalities, hypertension, diabetes, metabolic syndrome, kidney disease, rheumatic fever, and certain chemotherapy drugs.

Risk factors for heart failure are age over 65 years, a family history (close relatives with congestive heart failure), obesity, a high-fat or high-salt diet, lack of exercise, smoking, drinking alcohol, and using recreational drugs like cocaine.

What are the signs and symptoms of heart failure?

Heart failure symptoms include shortness of breath, chest discomfort, palpitations, fatigue, swelling in the lower legs, ankles, and feet, weight gain, a dry hacking cough, getting up at night to urinate, bloating, nausea, and loss of appetite.

What are the four stages of heart failure?

As mentioned, heart failure is a long-lasting condition that slowly gets worse. Doctors diagnose heart failure based on blood tests, stress tests, and other tests. Healthcare providers classify congestive heart failure into four stages based on the severity of the symptoms.

Stage A: Your heart is working properly, but you are at increased risk of developing heart failure due to a personal history of medical conditions, which are risk factors for heart failure, or a family history of congestive heart failure.
Stage B: A pre-heart-failure stage. Your left ventricle has a structural abnormality or is not working normally, but you don’t experience symptoms related to heart failure.
Stage C: There is a confirmed diagnosis and current or previous heart failure symptoms.
Stage D: The final stage of advanced heart failure is when your ejection fraction is reduced, and you have severe symptoms of heart failure that do not respond to treatment.

What are the New York Heart Association stages of heart failure?

The New York Heart Association (NYHA) classification of heart failure is as follows based on the presence of symptoms such as breathlessness, palpitations, or fatigue:

Class 1: Active lifestyle with no limitation in activity. Ordinary levels of activity do not cause any of the symptoms mentioned above.
Class 2: Minor limitation in physical activity. Comfortable at rest, but typical levels of physical activity cause symptoms.
Class 3: Marked limitation in activity. Comfortable at rest, but even low levels of physical activity cause symptoms.
Class 4: Symptoms are present at rest. Any activity causes symptoms and discomfort.

What is the treatment for the different stages of heart failure?

Lifestyle changes, medications, and surgical procedures are used to treat heart failure. The treatment plan is different for each person and depends on the underlying cause and symptoms. In general, treatment options are as follows:

Treatment for stage A heart failure

Get regular low-intensity exercise (for example, walking).
Stop smoking, alcohol, and recreational drugs.
Eat a low-sodium, heart-healthy diet.
Take medications for high blood pressure (for example, angiotensin converting enzyme inhibitors and angiotensin II receptor blocker); high cholesterol (for example, statins), diabetes (for example, SGLT2 inhibitors such as dapagliflozin (Farxiga) and empagliflozin (Jardiance)), and vascular conditions.

Treatment plan for stage B heart failure

The treatment for stage B heart failure is the same as stage A, with the use of medications such as ACE inhibitors, ARBs, beta blockers, and aldosterone agonists, depending on your ejection fraction and history of heart attacks. Surgical procedures may be done to treat coronary artery blockage (blockage in the blood vessels that supply blood to the heart), valvular heart disease, or structural heart disease.

Treatment for stage C heart failure

This treatment is the same as the treatments for stages A and B with medications and treatments such as:

ACE inhibitors
ARBs
Beta blockers
Aldosterone agonists
SGLT2 inhibitors
Combination of hydralazine and nitrate if you cannot take ACE inhibitors or ARBs
Diuretics (water pills)
Salt restriction
Possible restriction on fluid intake
Daily weight tracking
Cardiac catheterization
Placement of an ICD device (implantable cardiac defibrillator)
Cardiac resynchronization therapy (placement of a biventricular pacemaker)
Valve replacement

Treatment plan for stage D congestive heart failure

Stage D treatment is also the same as previous stages. The stage D treatment plan may also include more advanced treatment options for advanced symptoms in this severe stage:

Left ventricular assist device
Cardiac transplant
Inotropic drugs that increase the force of heart muscle contractions (for example, digoxin, dobutamine, dopamine, norepinephrine, milrinone, levosimendan) while awaiting a heart transplant or until escalated supportive therapy is being planned
Palliative care

It is worth noting that an important part of the treatment for any stage of congestive heart failure is the treatment of underlying health conditions that cause or worsen heart failure, such as obesity, hypertension, high cholesterol, diabetes, atrial fibrillation, coronary artery disease, lung disease, and kidney disease.

What are the last signs of congestive heart failure?

The last signs of end-stage congestive heart failure may include breathlessness with minimal exertion, severe swelling due to fluid retention, extreme fatigue, chest pain, irregular heartbeat, persistent cough, nausea, loss of appetite, insomnia, cognitive impairment (speech and memory problems), depression and anxiety.

How long do most people live after being diagnosed with congestive heart failure?

Approximately half of all patients die within 5 years of a heart failure diagnosis.

However, people can live for widely varying amounts of time after being diagnosed with congestive heart failure, depending on the severity of the condition and other factors like age and co-existing health problems.

For example, life expectancy for a person who is under 50 years of age and otherwise low risk may be up to 20 years after a heart failure diagnosis. On the other hand, life expectancy for a person in their 80s who is at high risk may be less than 3 years after developing heart failure.