Classification and Stages of Heart Failure

Have you ever noticed that no single patient receives the same treatment from the same doctor, even if they have the same diagnosis? Why does it happen? It is because they must have different levels of severity. For instance, heart failure has different stages, and each stage may be associated with different types of symptoms. And to manage that, you may need a specific plan of treatment.

With a great understanding of the diseases, doctors now prefer to use an individualized approach to treat each patient. Meaning, you will get the treatment according to your specific condition, general health, and severity of the disease.  

Likewise, Heart Failure has different stages and classifications, which not only help the doctor understand the unique condition but also to select the most suitable treatment. Let’s talk about the classification and stages of heart failure in detail:

What is Heart Failure?

Heart Failure, as the name indicates, means your heart fails to perform its normal pumping action to supply blood. Although it is termed as heart failure, your heart has not completely failed, and just become insufficient to meet your body's needs. Heart failure can occur due to any heart disease, but the severity of the condition defines its stage. End-stage cardiac disease symptoms may be different and more critical to manage compared to early stages. 

Heart failure happens mostly because of any of the following heart conditions:

• Coronary Artery Disease

• High Blood Pressure

• Congenital Heart Defects

• Valvular Heart Disease

What's the difference between heart failure and a heart attack?

Like many patients, you may confuse the term heart failure with a heart attack, but let’s make it clear that both are different. 

A heart attack will happen if your heart suddenly gets deprived of oxygen-rich blood due to a blockage in an artery. The symptoms include sudden, sharp chest pain, shortness of breath, and nausea. Due to this, the heart muscles begin to die, which is an emergency condition and requires critical care. 

On the other hand, heart failure progresses over time, where the heart becomes insufficient to pump enough blood. The symptoms get worse over time, and even the simplest task becomes difficult.

Stages of Heart Failure:

Heart Failure stages define how severe the condition of the patient is. When we classify heart failure into stages, it helps us describe the level of function and the treatment you need. According to the severity level, it has four stages, A to D, as described below: 

Stage A: (Risk of Heart Failure)

It is the earliest stage of heart failure, where you notice mild or no symptoms at all. Most of the patients at this stage of the disease don’t even realize that they have a heart condition. It’s difficult to diagnose heart failure at this stage, merely based on symptoms. Your doctor will treat you by preventing the progression of this disease by modifying lifestyle, including a balanced diet and physical activity. Risk factors like smoking, high blood pressure, and high cholesterol can also be managed here.

Stage B: (Pre-Heart Failure)

Here, the patient may feel moderate symptoms, especially when he performs physical activity. On diagnostic procedures, there will be signs of structural damage and raised pressure in the heart. Treatment may involve medications and lifestyle modifications.

Stage C: (Symptomatic Heart Failure)

As the patient progresses to this stage, symptoms of heart failure become more prominent, and the patient may feel shortness of breath during walking and swelling in the lower body. Structural damage to the heart is more severe and may need a combination treatment involving medications, lifestyle modification, and surgical procedures.

Stage D: (Advanced Heart Failure)

Stage D is the most severe form of heart failure, where the patient may feel exhausted even at rest. Most of the time, recovery is tough at stage 4 congestive heart failure, and the patient may need heart devices and even a heart transplant. 

Classification of Heart Failure:

Further classification of heart failure is for patients who are already at stage C or D. This classification usually helps your doctor understand your condition better by assessing your functional limitations and decreased heart muscle strength that occurs due to heart failure. Both classifications are mentioned below:

According to the functional limitation:

New York Heart Association (NYHA) classes Heart Failure into the following 4 stages:

Class I: In this class, you may be able to perform simple activities without any limitation and do not have heart failure symptoms at rest.

Class II: You may experience mild limitation during physical activities and experience shortness of breath, but not at rest.

Class III: Simple daily tasks may be difficult to perform and come with chest pain or fatigue, and you will experience considerable limitations in your physical activity.

Class IV: You will experience severe functional limitation at this stage, even at rest, and any activity will lead to discomfort.

According to the ejection fraction:

Ejection fraction measures the amount of blood that your heart supplies to your body with each contraction. This classification system tells us how much strength your heart muscles have to pump blood. The normal range of ejection fraction is 50% to 70% and it decreases as the heart failure progresses. Let's classify heart failure according to this percentage:

50 to 70% (without Heart Failure symptoms): This is usually considered normal, and in this stage, no symptoms appear.

50 to 70% (with Heart Failure symptoms): In this stage, symptoms of heart failure occur, but ejection fraction remains normal, and that is why it is also known as Heart Failure with preserved ejection fraction (HFpEF). 

40 to 50%: A stage where ejection fraction is reduced but still above 40%, it is the Heart Failure with mildly reduced ejection fraction (HFmrEF). 

<40%: If the percentage falls below 40%, it is known as Heart Failure with reduced ejection fraction (HFrEF). Oxygen saturation in heart failure reduces further with each stage, which means your body is deprived of oxygen-rich blood to perform normal functions. 

Why do we need to assess the stage and classify Heart Failure?

The importance of assessing the stage and class of Heart Failure lies in the effectiveness of the treatment your doctor will plan. After assessing the symptoms that appear, the stage of Heart Failure, and the ejection fraction, your doctor will plan an individualized treatment plan. This not only helps increase the effectiveness of the treatment chosen, but you will also better understand why your doctor has chosen a specific treatment for you. It means you will respond better and recover quickly. 

Treatment variations exist because each patient is unique and may need medications or procedures according to the stage of Heart Failure.

What happens in Stage 4 Heart Failure?

Stage 4 Heart Failure is an end-stage heart failure in which you experience the symptoms even at rest. Your quality of life is severely impaired, and you will receive palliative treatment, meaning your doctor will treat your condition to improve your quality of life and reduce symptoms. The symptoms may include the following:

Symptoms of stage 4 heart failure:

• Shortness of breath (even at rest)

• Cough or wheezing

• Swelling in legs, ankles, feet, or abdomen

• Irregular heartbeat

• Fatigue 

• Nausea 

• Confusion

• Not being able to perform simple tasks like walking

• Frequent urination at night

What are Heart Assisting Devices?

Heart-assisting devices help compensate for the loss of heart function. Your doctor will recommend a device based on your suitability. A pacemaker device helps improve the rhythm of your heartbeat, and a ventricular assist device helps pump blood. Sometimes, a doctor suggests a heart transplant to a patient, but due to the unavailability of a suitable donor, they have to live with a cardiac device such as a Left Ventricular Assist Device (LVAD), which supports failing hearts. LVAD is surgically implanted in your heart and helps pump blood. 

Now you may be wondering if it is a permanent treatment. Well, it may be a destination therapy for you if you are not suitable for a surgery like a heart transplant. Otherwise, it is used as a bridge to transplant until you get a suitable donor. Life after LVAD may need lifestyle adjustments, such as wearing LVAD gear like an LVAD shirt, an LVAD tank top, or LVAD shorts to carry components like batteries and the controller. But it greatly improves the patient’s symptoms and their quality of life. 

Final Remarks

Understanding stages and classification of Heart Failure is important as it helps your doctor treat you more effectively and make a plan that works best for you. It may also help you to understand your condition and how much you need a particular treatment. 

FAQs

How long can you live with stage 4 heart failure?

Stage 4 heart failure has a limited life expectancy of 8 to 12 months as compared to earlier stages. However, the survival may vary according to unique medical and individual factors. 

What is the life expectancy of stage 3 Heart Failure?

Stage 3 heart failure, when treated with medications and surgical procedures like LVAD implantation and Heart Transplant, may live up to 5 to 10 years.

Does a pacemaker device help with Heart Failure?

If heart failure occurs due to a slow heartbeat or abnormal rhythm, a pacemaker may help improve the symptoms of Heart Failure.