Heart Failure Treatment by Stage

Medically Reviewed by James Beckerman, MD, FACC on August 04, 2024
Written by WebMD Editorial Contributors
3 min read

The ''Stages of Heart Failure,'' developed by the American Heart Association (AHA) and American College of Cardiology (ACC), will help you understand that heart failure is often a progressive condition and can worsen over time. The stages will also help you understand why a new medication was added to your treatment plan and why lifestyle changes and other treatments are needed.

Note: The stages classified by the AHA and ACC are different from the New York Heart Association (NYHA) clinical classifications of heart failure. NYHA ranks patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your health care provider what stage of heart failure you are in.

Check the table below to see if your therapy matches what the AHA and ACC recommend. The table below outlines a basic plan of care that may or may not apply to you. Ask your doctor or nurse to explain the therapies that are listed if you do not understand why you are or are not receiving them.

StageDefinition of StageUsual Treatments
Stage A

People at high risk of developing heart failure (pre-heart failure), including people with:

  • High blood pressure
  • Diabetes
  • Coronary artery disease
  • Metabolic syndrome
  • History of cardiotoxic drug therapy
  • History of alcohol abuse
  • History of rheumatic fever
  • Family history of cardiomyopathy

 

 

Stage BPeople who have developed structural heart disease that is strongly associated with the development of heart failure (such as those with a history of heart attack, those with a low ejection fraction, valve disease with no symptoms) but without signs and symptoms of heart failure.
  • Treatment methods above for Stage A apply.
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitor),angiotensin II receptor blocker (ARB), or or angiotensin receptor neprilysin inhibitors (ARNI) like sacubitril/valsartan (Entresto). which is indicated for the treatment of patients with chronic heart failure.
  • Beta-blockers should be considered for everyone.
  • Surgery options for coronary artery bypass and valve repair or replacement (as appropriate).
Stage C

Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include:

 

  • Shortness of breath
  • Fatigue
  • Reduced ability to exercise

 

  • Treatment methods above for Stage A apply.
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitor) and beta-blocker.
  • 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).
  • Drugs that worsen the condition should be discontinued.
  • Some patients may benefit from other medicines such as hydralazine (Apresoline) or nitrates.
  • Some patients may be candidates for biventricular pacing or an implantable defibrillator.
Stage DPatients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.
  • Treatment methods for Stages A, B & C apply.
  • 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 heart pump drugs, and end-of-life (palliative or hospice) care.