The Stages of Heart Failure

  • Man with doctor
    Heart failure stages guide treatment options.
    Heart failure, when your heart does not pump well enough to meet your body’s need for blood and oxygen, is a chronic condition that worsens over time. The American College of Cardiology and the American Heart Association have defined four stages of heart failure, Stages A through D. These not only explain the progression of this condition, but can also be used to help provide guidelines for treatment. If you are someone who has been diagnosed with heart failure, it’s important to understand what stage you’re in and what treatment options are available.  Let’s examine each stage in more detail.

  • Blood pressure gauge in Doctors surgery
    Stage A
    If you are Stage A, you can engage in normal activities without difficulty and don’t show any signs of heart failure during an examination by a doctor. Yet you are considered high-risk for developing heart failure in the future. Certain medical conditions contribute to this risk, such as obesity, high blood pressure, diabetes, and coronary artery disease. You may also be considered Stage A if you take medications that can damage your heart or if you have a family history of heart failure.



  • Man carrying full shopping basket in grocery store
    Treatment for Stage A
    Since you don’t have heart failure yet, treatment is aimed at decreasing your risk factors.  Incorporate regular activity into your daily routine, and lose weight if necessary. Eat a nutrient-rich diet, and avoid processed foods that are high in fat and sodium.  Try to control cholesterol and blood pressure. Eliminate cigarettes, alcohol, and recreational drugs. Manage your diabetes carefully. Your doctor may consider two types of medication, especially if you have diabetes or high blood pressure: a beta-blocker or an angiotensin converting enzyme inhibitor (ACE-I)/ angiotensin II receptor blocker (ARB). These can help lower blood pressure and decrease how hard your heart has to work.

  • Acoustic stethoscope and blood pressure gauge on an electrocardiogram printout
    Stage B
    In Stage B, your heart has structural damage, but you don’t have any symptoms of heart failure. You may have had a previous heart attack or have heart valve disease without any complications. The left ventricle of your heart may not be functioning as well as it should. If you had an echocardiogram, it would probably show a low ejection fraction, meaning that your heart is not pumping out as much blood as is should with each heartbeat. 



  • Medicine Holding Stent
    Treatment for Stage B
    Any treatments or lifestyle changes you made for Stage A will likely continue for Stage B. If your doctor has not yet started you on a beta-blocker, ACE-I, or ARB, you’ll probably begin taking this medication now. Your doctor may also add another medicine known as an aldosterone antagonist. This can help with sodium and water retention, making it easier for your heart to pump.  Underlying cardiac issues may be addressed if needed, such as valve replacement surgery or having a stent placed for a blocked artery.

  • Pensive man
    Stage C
    When you start experiencing symptoms of heart failure, you have reached Stage C. You may notice that you feel short of breath or have difficulty performing physical activity. You probably feel tired and sluggish. Fluid can build up in your feet, ankles, legs and abdomen, and you may need to urinate more frequently. You may develop a persistent cough if you have fluid in your lungs.

  • doctor-holding-pacemaker
    Treatment for Stage C
    You may continue with treatments from Stages A and B. If you are not currently taking any of the medications discussed in the previous stages, your doctor may add them now. You’ll probably need to restrict sodium in your diet, and maybe fluids as well. Your doctor may prescribe a diuretic to help with excess fluid. Other medications include a hydralazine-nitrate combination to help relax the blood vessels, and digitalis (digoxin) to slow the heart rate but strengthen its contraction. If you’re having problems with your heart rhythm, you may be a candidate for a pacemaker or an implantable defibrillator.

  • Man in hospital bed
    Stage D
    During this final stage of heart failure, you feel symptoms even at rest. Medication alone no longer allows you to carry on life as normal. You may experience frequent hospitalizations and require close monitoring in intensive care. You may need surgery or special interventions to survive.

  • surgery
    Treatment for Stage D
    More advanced treatments are needed at this point. A careful evaluation is necessary to see what options are best. Some of these include: a continuous infusion of medication to control your heart rate, a ventricular assist device (VAD) that is implanted into your chest or abdomen to help your heart pump blood, a trial of an experimental drug or surgery, or a heart transplant. Palliative, end-of-life care is another consideration for those who choose to stop all medical interventions except for those that are used for comfort.

  • portrait-of-serious-man
    Living with Heart Failure
    Though there is no cure for heart failure, sticking to your treatment plan can help you live longer and feel better. Continue to make healthy lifestyle modifications and follow your doctor’s recommendations for activity. Take your medication as prescribed, and keep all of your doctor’s appointments. Don’t forget to address the emotional side as well. It’s normal to feel worried or depressed at times, so reach out for support if you need it. Remember you can always talk to your doctor and healthcare team about any questions or concerns that arise.

The Stages of Heart Failure

About The Author

Erin Azuse, RN, has been a registered nurse for 18 years, working in neonatal intensive care and pediatrics. She specializes in creating educational materials for patients, consumers, and other healthcare providers, as well as content marketing for private physicians’ practices, medical device companies, and nursing schools.
  1. ACCF and AHA Release Guidelines on the Management of Heart Failure. American Family Physician. http://www.aafp.org/afp/2014/0801/p186.html
  2. Classes of Heart Failure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp#.WLWx9BIrLOQ
  3. Goldberg LR. Stage B Heart Failure: Management of Asymptomatic Left Ventricular Systolic Dysfunction. Circulation. 2006;113(24):2851-2860. doi:10.1161/circulationaha.105.600437.
  4. Understanding Heart Failure: Stages. Cleveland Clinic. http://my.clevelandclinic.org/health/articles/heart-failure/stages
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Last Review Date: 2019 Mar 16
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