What is the ACCF/AHA staging system for heart failure?

Updated: Mar 02, 2021
  • Author: Ioana Dumitru, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) staging system complements the NYHA classification to reflect the progression of disease and comprises four stages, as shown in Table 5 below. [3]

Table 5. American College of Cardiology Foundation/American Heart Association (ACCF/AHA) heart failure staging system (Open Table in a new window)

Level

Description

Examples

Notes

A

At high risk for heart failure but without structural heart disease or symptoms of heart failure

Patients with coronary artery disease, hypertension, or diabetes mellitus without impaired left ventricular (LV) function, LV hypertrophy (LVH), or geometric chamber distortion

Patients with predisposing risk factors for developing heart failure

No corresponding New York Heart Association (NYHA) functional classification

B

Structural heart disease but without signs/symptoms of heart failure

Patients who are asymptomatic but who have LVH and/or impaired LV function

Corresponds with patients with NYHA class I

C

Structural heart disease with current or past symptoms of heart failure

Patients with known structural heart disease and shortness of breath and fatigue, as well as reduced exercise tolerance

The majority of patients with heart failure are in this stage

Corresponds with NYHA classes I, II, III and IV

D

Refractory heart failure requiring specialized interventions

Patients who have marked symptoms at rest despite maximal medical therapy

Patients in this stage may be eligible to receive mechanical circulatory support, receive continuous inotropic infusions, undergo procedures to facilitate fluid removal, or undergo heart transplantation or other procedures

Corresponds with patients with NYHA class IV


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