Classifying Heart Failure
The 2022 AHA/ACC/HFSA guidelines include four stages of heart failure:
Stage A includes at risk patients without symptoms, structural heart diseas or cardiac biomarkers of heart stretch or injury. They include patients with risk factors associated with heart failure.
Stage B includes patients who are pre-heart Failure with one of the following: structural heart disease, increased filling pressures, and risk factors.
Stage C are patients who have symptoms of heart failure as described above in diastolic and systolic failure.
Stage D includes patients with advanced heart failure. These patients have severe symptoms that interfere with daily life that often lead to hospitalizations.
The literature reveals three major heart failure classification systems used to guide treatment plans. The New York Heart Association classifies patient status by the type and level of functional impairment related to HF. The American College of Cardiology and the American Heart Association Stages of Heart Failure focus on the structural cardiovascular changes responsible for symptoms. The European Society of Cardiology classifies HF in terms of the hearts ability to function as a pump.
New York Heart Association (NYHA) Classification
The NYHA classification is used to characterize symptoms and functional capacity of patients with symptomatic (stage C) HF or advanced HF (stage D). This classification system is widely used even though it is short on validity. It is often used to determine treatment strategies (Caraballo et al., 2019). See figure 2.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063#d1e2675
European Society of Cardiology (ESC)
The ESC includes a diagnostic algorithm
Pretest to assess for HF signs and symptoms
Diagnostic laboratory tests
Points are given for major and minor criterion (Bozkurt et al., 2021).
Instant Feedback:
In diastolic heart failure the ventricle loses its ability to relax or stretch.
References:
Bozkurt B, Coats AJS, Tsutsui H, et al., (2021). Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J. Card Fail. 27,387–413.
Caraballo, C., Desai, N.R, Mulder, H. et al., (2019). Clinical implications of the New York Heart Association Classification. J Am Heart Assoc. 8: e014240
Heidenreich, P. A., Bozkurt, B., Aguilar, D. et al., (2022) 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 145(18), e876-e894.
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