Heart Failure Classification - Stages of Heart Failure and Their Treatments

Doctors often describe the severity of heart failure by how much the patient's physical activity is limited.

One of the most frequently used heart failure classification systems that doctors use is the New York Heart Association (NYHA) Functional Classification. Each class in this system describes a patient's symptoms while performing physical activities. Classifying heart failure based on how a person functions during exertion is a strong indicator of the patient's outcome.

Description of the NYHA Functional Classification

Heart Failure Classifications

The American College of Cardiology (ACC) and the American Heart Association (AHA) developed a different classification system for heart failure. The ACC/AHA system does not replace, but complements, the NYHA system, and identifies a patient class not present in the NYHA Classification – those patients who don't have heart failure, but are at high risk for developing the condition.

The ACC/AHA Stages of Heart Failure

ACC/AHA Stage Symptoms
A At high risk for heart failure but without structural heart disease or symptoms of heart failure.
B Structural heart disease but without signs or symptoms of heart failure.
C Structural heart disease with prior or current symptoms of heart failure.
D Refractory heart failure requiring specialized interventions.

The Most Common Treatments for Each Stage of Heart Failure

Receiving the proper treatment at the right stage during heart failure is important to stop or slow down the progression of heart failure. The most common treatments for heart failure are:

ACC/AHA Stage Treatment


(At high risk for heart failure)
  • Quit smoking.
  • Exercise regularly
  • Treat high blood pressure
  • Treat lipid disorders
  • Discontinue alcohol or illegal drug use
  • If you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions, taking medications as prescribed


(Heart disease, without signs of heart failure)
  • All patients should take an ACE inhibitor or ARB
  • Beta-blockers should be prescribed for patients after a heart attack
  • Surgery options should be discussed for coronary artery or valve disease


(Heart disease, with signs of heart failure)
  • African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist
  • Diuretics (water pills) and digoxin may be prescribed if symptoms persist
  • An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies
  • Restrict dietary sodium (salt)
  • Monitor weight
  • Restrict fluids (as appropriate)
  • Pacemaker or ICD may be recommended


(Heart failure not responding to treatments)

Patient should be evaluated to determine if the following treatments are available options:
  • Heart transplant
  • Ventricular assist devices
  • Surgery options
  • Research therapies
  • Continuous infusion of intravenous inotropic drugs
  • End-of-life (palliative or hospice) care

We can help you get the right heart failure treatment. The heart failure program at Penn Medicine is the largest on the East Coast with specialized cardiologists that are solely dedicated to treating you, or your loved ones living with heart failure, or its affects. To learn more about how the program can help, schedule a consultation today.

About this Blog

The Penn Heart and Vascular blog provides the latest information on heart disease prevention, nutrition and breakthroughs in cardiovascular care.

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