Development and Staging of Heart Failure
American College of Cardiology and the American Heart Association have published guidelines for the evaluation and management of chronic heart failure. These guidelines define 4 stages of HF, emphasizing its evolution and progression ( Fig.3221).12011
The 4 stages involved in the development of the HF syndrome are designated Stages A-D. In Stages A and B, patients are best defined as those with risk factors that clearly predispose toward the development of HF.
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Stage A: Patients with stage A HF are at high risk for developing HF, but have no apparent structural abnormality of the heart. Patients with coronary artery disease, hypertension, or diabetes mellitus who do not yet demonstrate impaired left ventricular (LV) function, hypertrophy, or geometric chamber distortion would be considered Stage A.
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Stage B: Patients with stage B HF have never had symptoms of HF but have structural abnormalities of the heart. Patients who are asymptomatic but demonstrate LV hypertrophy (LVH) or impaired LV function would be designated as Stage B.
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Stage C: Patients with current or past symptoms of HF associated with underlying structural heart disease would be designated Stage C.
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Stage D: Patients have end-stage symptoms of HF that are refractory to standard treatments would be designated Stage D. These patients might be eligible for specialized, advanced treatment strategies, such as mechanical circulatory support, procedures to facilitate fluid removal, continuous inotropic infusions, or cardiac transplantation or other innovative or experimental surgical procedures, or for end-of-life care such as hospice. 12011, 12013
Figure 3221 – Stages in the Development of Heart Failure / Recommended Therapy by Stage
Figure 1,Page e9, J Am Coll Cardiol 2009;53(15), is used with permission of Elsevier Inc. All rights reserved.
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This 4 stage classification system, recognizing the progressive nature of the disease, identifies patients during the course of their disease development and specifies treatment strategies targeted at each stage to reduce the morbidity and mortality of HF. This staging system complements the traditional New York Heart Association (NYHA) functional classification, which primarily describes the functional limitations of patients who are in Stage C or Stage D. The NYHA functional classification assigns patients to 1 of 4 functional classes, depending on the degree of effort needed to elicit symptoms.12011
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Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea.
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Class II: Slight limitation of physical activity. Ordinary physical activity results in fatigue, palpitation, or dyspnea.
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Class III: Marked limitation of physical activity. Less-than-ordinary activity causes fatigue, palpitation, or dyspnea.
Content on this page was last changed on December 16, 2009.
References:| 11968. | Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. 2009;53(15):e1-e90. |
| 12011. | Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. 2009;53(15):e1-e90. |
| 12013. | Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348(20):2007-2018. |
| 12014. | Wilson JF. In the Clinic. Heart failure. Ann Intern Med. 2007;47(11):ITC12-1–ITC12-16. |
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