It is important to remember that many people with heart failure lead full, enjoyable lives. Also, not all heart failure is the same.
Heart failure can progress, so researchers have identified four stages of the disease — A, B, C and D. Health care professionals also classify heart failure when it has progressed to stages C and D. This classification measures a patient’s overall heart function and severity of symptoms.
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In collaboration with the American College of Cardiology, the AHA has identified four stages of heart failure. They are described in the table below.
| Stage A:
At risk for heart failure | People who are at risk for heart failure but do not yet have symptoms or structural or functional heart disease Risk factors for people in this stage include hypertension, coronary vascular disease, diabetes, obesity, exposure to cardiotoxic agents, genetic variants for cardiomyopathy and family history of cardiomyopathy |
Stage B:
Pre-heart failure | People without current or previous symptoms of heart failure but with either structural heart disease, increased filling pressures in the heart or other risk factors |
Stage C:
Symptomatic heart failure | People with current or previous symptoms of heart failure |
Stage D:
Advanced heart failure | People with heart failure symptoms that interfere with daily life functions or lead to repeated hospitalizations |
Classes of Heart Failure
By classifying patients in stage C and stage D heart failure, health care professionals better understand how to treat people in these more advanced stages. Health care professionals typically classify patients' heart failure according to the severity of their symptoms.
The most commonly used classification system, the New York Heart Association (NYHA) Functional Classification1, places patients in one of four categories based on limitations of physical activity.
If you are diagnosed with stage C or stage D heart failure, your health care professional will give you an NYHA Functional Classification as a baseline. Then, as you undergo treatment, your health care professional will assign another classification of your condition, allowing your care team to measure how well treatment is working.
The table below describes the different classes in the NYHA Functional Classification.
| Class | Patient Symptoms |
| I | No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or shortness of breath. |
| II | Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, shortness of breath or chest pain. |
| III | Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain.
|
| IV | Symptoms of heart failure at rest. Any physical activity causes further discomfort. |
Each state has its own agency that regulates and issues driver licenses, vehicle registrations, and disability parking placards. This branch is usually called the Department of Motor Vehicles (DMV). People who need a disability parking placard should contact their state agency directly.
1 Adapted from Dolgin M, Association NYH, Fox AC, Gorlin R, Levin RI, New York Heart Association. Criteria Committee. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Lippincott Williams and Wilkins; March 1, 1994.
Original source: Criteria Committee, New York Heart Association, Inc. Diseases of the Heart and Blood Vessels. Nomenclature and Criteria for diagnosis, 6th edition Boston, Little, Brown and Co. 1964, p 114.
©1994 American Heart Association, Inc.
Last Reviewed: Jun 7, 2023
FAQs
Heart failure can progress, so researchers have identified four stages of the disease — A, B, C and D. Health care professionals also classify heart failure when it has progressed to stages C and D. This classification measures a patient's overall heart function and severity of symptoms.
What are the 4 classes of CHF? ›
New York Heart Association Functional Classification
- Class I: Symptom onset with more than ordinary level of activity.
- Class II: Symptom onset with an ordinary level of activity.
- Class III: Symptom onset with minimal activity.
- Class IIIa: No dyspnea at rest. ...
- Class IV: Symptoms at rest.
About half of people who develop heart failure die within 5 years of diagnosis. 3. Most people with end-stage heart failure have a life expectancy of less than 1 year.
What is the difference between Class 1 and Class 2 heart failure? ›
NYHA Classification - The Stages of Heart Failure: Class I - No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc. Class II - Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.
How do I know what stage of heart failure I have? ›
Stages of heart failure
class 1 – you don't have any symptoms during normal physical activity. class 2 – you're comfortable at rest, but normal physical activity triggers symptoms. class 3 – you're comfortable at rest, but minor physical activity triggers symptoms.
Can you get better from Stage 4 heart failure? ›
For most people, heart failure is a long-term condition that can't be cured. But treatment can help keep the symptoms under control, possibly for many years. The main treatments are: healthy lifestyle changes.
What is the life expectancy of someone with congestive heart failure? ›
Despite its name, CHF does not mean the heart has completely failed. However, CHF can be life threatening if left untreated. In general, more than half of all people with CHF survive for 5 years after diagnosis, according to a 2019 systematic review and meta‐analysis . About 35% survive for 10 years.
What stage of heart failure are swollen legs? ›
Stage C: People show symptoms of heart failure, including fatigue, breathlessness, and edema. However, edema may not be a prominent feature, or it may be milder and localized. Stage D: In stage D, edema becomes more apparent.
How quickly does heart failure progress? ›
It's very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly.
How do you know the end is near with congestive heart failure? ›
The symptoms of end stage heart disease include trouble breathing, exhaustion, weight loss, changes in skin color, swelling, and abdominal pain all or most of the time. These can progressively worsen. Caring for someone with end stage heart failure may involve providing physical and emotional support.
Symptoms that may indicate that heart failure is getting worse may include:
- increased shortness of breath.
- swelling in the ankles, legs, abdomen, or other parts of your body.
- fatigue.
- chest discomfort.
- sudden weight gain.
- reduced exercise tolerance.
- persistent cough or wheezing.
- increased heart rate.
In Stage 3, patients experience symptoms that limit their everyday activities. These can include shortness of breath, fluid in the lower extremities, chest pain, abdominal pain, bloating, nausea, and fatigue. In Stage 4, symptoms will worsen for the patient and will not improve with treatment.
How bad is class 4 in heart failure? ›
Class 4 heart failure.
Shortness of breath occurs even at rest. This category includes the most severe heart failure.
What are three things that can worsen heart failure and why? ›
Factors that can worsen symptoms of heart failure
anaemia (a condition where the blood doesn't have enough healthy red blood cells) too much salt, fluid, or alcohol in your diet. pregnancy. some viral and bacterial infections.
What is the most common cause of death in heart failure patients? ›
Approximately 90% of heart failure patients die from cardiovascular causes.
What is life expectancy with heart failure? ›
While no one can predict exactly how heart failure will affect someone's life or how it may shorten a life, in general, more than half of all people diagnosed with congestive heart failure will survive for five years. About 35% will survive for 10 years.
What is the life expectancy of a person with congestive heart failure? ›
A lot will depend on which stage of your condition you are in and your overall health. The good news is that advancements are constantly being made in treating CHF. However, despite the advancements, 5 years is the life expectancy of about 50% of those diagnosed with CHF.
