What Are the Four Stages of Congestive Heart Failure?

Caregiver providing home health care to congestive heart failure patient

Written by Amedisys

A diagnosis of congestive heart failure can feel overwhelming. If you or a loved one has recently received this diagnosis, you may have many questions. Learning more about congestive heart failure can help you understand what to expect. It can be especially helpful to understand what the four stages of congestive heart failure are, along with your options for care.

Understanding Congestive Heart Failure: An Overview

Congestive heart failure, also called simply “heart failure” or CHF, is a chronic health condition caused by weakened heart muscle. If healthy, your heart squeezes with enough force during each heartbeat to pump enough blood for your body to function normally. In congestive heart failure, blood is not pushed out of the heart with enough force, causing other health problems.

According to the Centers for Disease Control and Prevention (CDC), more than 6 million adults in the United States have congestive heart failure. People who are smokers, have obesity, coronary artery disease (CAD), valvular heart disease, diabetes or high blood pressure are all at increased risk for CHF.

Congestive heart failure can cause many symptoms that lead to poor quality of life. These symptoms include:

  • Shortness of breath
  • Swelling of body tissues due to fluid buildup
  • Chronic coughing and/or wheezing
  • Decreased appetite and nausea
  • Fatigue
  • Elevated heart rate
  • Confusion and problems with thinking
  • Sudden weight changes

The Four Stages of Congestive Heart Failure Explained

Congestive heart failure is a progressive disease, meaning it does not go away or reverse course and gradually worsens over time. The American Heart Association has defined four stages of congestive heart failure, beginning with pre-heart heart failure or stage A, through the final or end-stage of heart failure.

Stage A: Pre-Heart Failure

People diagnosed with Stage A heart failure don’t have a problem with their heart’s structure but are at risk for developing the later stages of heart failure. Treatment at this stage is focused on preventing new problems. Patients are educated on healthy lifestyle choices that can help prevent coronary artery disease and sometimes may be prescribed medications that reduce their risk for developing heart problems.

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Stage B: Asymptomatic Heart Failure

In Stage B heart failure, the heart has begun to show signs of structural changes. For example, this can be an enlarged left ventricle (a section of the heart), along with a decreased ejection fraction (EF), which measures how much blood the heart pumps. In Stage B there are not any symptoms of heart failure (and there have not been in the past). Treatment at this stage includes preventing symptoms from beginning and treating with medications called beta blockers and ace inhibitors (or angiotensin-receptor blockers) as appropriate to reduce the rate of heart structure changes, as well as lifestyle changes that will prevent worsening of further structural changes in the heart. Treatment may also include surgery, such as coronary artery bypass grafting (CABG) or valve replacement if it is determined that a blocked coronary artery or defective heart valve is the cause of structural changes in the heart.

Stage C: Symptomatic Heart Failure

Stage C heart failure results in symptoms of heart failure, either in the past or currently. Treatment at this stage includes reducing or controlling symptoms and improving quality of life. It can also work to control any other health conditions that can worsen heart failure. Medications that reduce extra fluid in the body and other complications of heart failure may be added. In some cases, implanted devices such as a pacemaker or cardioverter defibrillator, may be used to support the heart.

Stage D: End-Stage Heart Failure

During Stage D, or end-stage heart failure, symptoms are uncomfortable and always present, even during rest. Treatment in this stage includes improving quality of life, reducing symptoms, reducing trips to the hospital and making end-of-life goals and plans. For some, a heart transplant may be an option.

Early-Stage Heart Failure: Knowing Your Options

For those living with Stage C heart failure, day-to-day care can sometimes feel challenging. Hospitalizations may be a worry, and managing stability and quality of life at home requires lifestyle changes, medications and a good plan of care.

Home health support for heart failure can help you learn how to monitor symptoms and manage your condition at home, avoiding hospital stays. Home health care can provide:

  • Education about medications and lifestyle modifications to reduce the risk factors and help promote clinical stability.
  • Proper diet and nutrition information
  • Techniques for improvements in strength and mobility
  • Daily exercise routines
  • Help to monitor vital signs
  • Monitoring heart failure symptoms
  • Weight monitoring and management
  • Tips on what to do if symptoms worsen

These supports and resources can help improve your quality of life and reduce symptoms during Stage C heart failure.

End-Stage Heart Failure: Knowing Your Options

Because heart failure is not reversible, end-stage heart failure can escalate the need for decisions about care and end of life if you haven’t already had these conversations with your loved ones and care team. People living with end-stage heart failure often have symptoms and problems that can lead to hospitalizations and emergencies.

Understanding the four stages of heart failure and discussing your long-term goals and wishes in the early stages can help you avoid unwanted and potentially unnecessary treatments.

Palliative Care and Heart Failure

Palliative care is a helpful option for those living with heart failure. The focus of palliative care is on quality of life, symptom management and setting goals for care so that your wishes are honored, and your treatment matches what you desire.

Palliative care can be started at any stage of a diagnosis. As you progress into the later stages of heart failure, you may meet more often with your palliative care team to discuss symptom management and to plan for possible changes to your health and care. The palliative care team can also help you decide when to begin hospice care during Stage D heart failure.

Hospice Care: Compassion During the Final Stage

During hospice care, people living with heart failure transition from aggressive forms of treatment to comfort-centered, end-of-life care. An interdisciplinary hospice care team helps patients and their families to manage heart failure at home as best as possible.

Specialized hospice care for heart failure can further support those in end-stage heart failure, with evidence-based guidelines and best practices to keep patients as comfortable as possible where they most want to be.

During end-stage heart failure, hospice care provides:

Managing the Four Stages of Congestive Heart Failure with Amedisys

If you’re not sure where to begin with heart failure care at home, an Amedisys care center near you can help. Whether you enroll in our home health heart failure program, meet with a palliative care team or are considering hospice, contact us today for more information.

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