What are the Four Stages of Congestive Heart Failure?

Receiving a diagnosis of heart failure from your doctor can feel like a death sentence. After all, you need your heart to survive. When it fails, so does the rest of your body.

Heart failure can mean many things, making context key. There are four stages of heart failure, and knowing these stages can provide insight on how to manage it and how to slow down the progression to live an enjoyable life. Luke Cunningham, M.D., an advanced heart failure, transplant and mechanical circulatory support cardiologist for INTEGRIS Health, shares insight on the four stages of heart failure and how to manage it.

What is congestive heart failure?

There are two sides of the heart that help pump blood to your body. The left side pumps blood to your organs, and the right side receives blood and pumps it to your lungs to take in more oxygen.

When congestive heart failure occurs, either side of the heart can be impacted. Left ventricular (LV) heart failure means the left ventricle isn’t strong enough to pump blood to organs, and right ventricular (RV) heart failure means the right ventricle isn’t strong enough to pump blood to the lungs.

When the blood doesn’t flow properly through the veins, it backs up and can cause swelling in various tissues throughout the body. For example, swelling in the legs can lead to fluid buildup in the lungs that causes shortness of breath.

Most people with congestive heart failure suffer from left-sided heart failure. The left ventricle has the tedious task of working harder to pump blood to the entire body, therefore it’s larger and more prone to developing chronic issues. Systolic heart failure (left ventricle can’t contract normally) and diastolic heart failure (left ventricle can’t relax normally) are the two types of left-sided heart failure.

Once left-sided heart failure occurs, there’s a higher risk of also developing right-sided heart failure because blood flow backs up and creates an increase in pressure that causes swelling and congestion.

Congestive heart failure stages

Heart failure is a chronic condition that gets worse with time. There are four heart failure stages (stages A, B, C and D). They range from having a high risk of developing heart failure to having advanced heart failure with severe, life-threatening symptoms.

Here is an overview of the stages

• Stage A: At risk for heart failure
• Stage B: Pre-heart failure
• Stage C: Symptomatic heart failure
• Stage D: Advanced heart failure

Stage A

At-risk heart failure simply means heart failure has yet to occur, but you’re more likely to develop the issue based on preexisting conditions.

Some of these risk factors include family history, high blood pressure, cardiomyopathy, diabetes, coronary artery disease, metabolic syndrome or obesity.

Stage B

Pre-heart failure means you have heart failure that is diagnosed on imaging but has yet to produce symptoms. An ultrasound of the heart, called an echocardiogram, will show a structural change to the ventricle or abnormal cardiac function, leading to the diagnosis. An elevated natriuretic peptide test, indicating your heart isn't pumping as much blood as your body needs, will also result in the categorization of stage B heart failure.

Stage C

Symptomatic heart failure occurs when symptoms coincide with a structural or functional cardiac abnormality or a high peptide test result. People begin to notice physical changes caused by heart failure, which typically include coughing, shortness of breath, fatigue and swelling. However, they can vary depending on whether you have left- or right-sided heart failure.

Left-sided heart failure symptoms:

• Shortness of breath
• Coughing
• Fatigue
• Trouble concentrating
• Difficulty sleeping
• Loss of appetite

Right-sided heart failure symptoms:

• Nausea
• Abdominal pain
• Swelling (usually in legs and feet)
• Frequent urination
• Weight gain

Stage D 

At this point, symptoms associated with heart failure become more severe and advanced, such as trouble breathing even when sitting down. This stage is considered an end-stage disease because you need specialized care such as hospitalization or heart transplant. Symptoms don’t usually improve with treatment.

Can heart failure be reversed?

No, but lifestyle modifications and various treatment options can help slow the progression and reduce symptoms. 

“Heart failure is a lifelong disease and as a heart failure specialist, I want to build a relationship to help my patients manage symptoms to extend and improve their quality of life,” says Cunningham.

Living with heart failure

Reduce sodium intake: As heart failure progresses, fluid buildup becomes more problematic because the heart can’t pump blood as effectively. Excess sodium in your diet can lead to even more fluid retention, further exacerbating symptoms such as swelling or shortness of breath.

Supplement with medications: Diet and exercises usually aren’t enough to slow the progression of heart failure. Medications such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers and angiotensin II receptor blockers (ARB) can boost your heart’s efficiency over time.

Watch the scale: Carrying extra weight makes your heart work harder and puts more strain on the entire body. Watch what you eat and exercise regularly to keep your weight from fluctuating. 

Quit smoking: Smoking increases the risk of veins and arteries clogging, which can make heart failure progress faster.

Quit drinking: Alcohol consumption leads to high blood pressure, and having high blood pressure puts even more strain on the heart.

Prioritize sleep: Waking up often in the middle of the night causes both a spike in heart rate and blood pressure. Getting a good night’s sleep can help keep your heart functioning more effectively and avoid unnecessary strain.

Manage other medical conditions: Whether it’s diabetes, kidney disease, lung disease or high blood pressure, staying on top of other areas of your health can go a long way in keeping your heart failure in check.

Minimize stress: Chronic stress can lead to high blood pressure, which places more strain on the heart. Take care of your mental health by using techniques to lower stress, such as meditation or talk therapy.

How long can you live with congestive heart failure?

The five-year survival rate for people living with congestive heart failure is as follows, according to a study by the American Heart Association.

• Stage A: 97 percent
• Stage B: 96 percent
• Stage C: 75 percent
• Stage D: 20 percent

How is each stage of congestive heart failure treated?

Stage A treatment: If you are placed in the at-risk category of congestive heart failure, your doctor will recommend lifestyle changes. 

This includes:

• Quitting smoking
• Limiting or stopping alcohol consumption
• Incorporating more exercise into your routine
• Treating high cholesterol or high blood pressure with dietary modifications and medications.

Stage B treatment: In the event of structural or functional heart changes, you should take ACE inhibitors or angiotensin II receptor blockers. These drugs help make it easier for the heart to pump blood and can improve life expectancy. Beta blockers, which lower heart rate along with the force exerted when pumping, can also improve patient outcomes. In some cases of artery blockages, heart attack or valve disease, a surgery to repair the heart may be considered. 

Stage C treatment: For conservative treatments, a combination of lifestyle changes and drugs will be recommended. Treatments include the following to help limit fluid buildup:

• Reducing sodium intake
• Restricting liquid intake
• Diuretics (water pills) to remove excess fluids

If symptoms persist, your doctor may recommend a pacemaker to keep a normal heart rhythm or an implantable cardioverter defibrillator (ICD) to manage your heart rate.

Stage D treatment: Advanced treatment options usually involve surgery or a ventricular assist device (VAD). A VAD can either be connected to a pump outside the body or implanted in the chest during open-heart surgery. In either case, the device helps pump blood from the heart’s ventricles to the body. 

Surgery options may include:

• Aortic valve repair and replacement
• Coronary artery bypass grafting (CABG surgery)
• Heart transplant

Although a heart transplant is a major operation with side effects, survival rates are 85 percent to 90 percent one year after surgery, according to the National Heart, Blood and Lung Institute.

If you’re at risk of heart failure or currently have heart failure and need assistance managing or treating your condition, ask your doctor to set you up with our advanced cardiac care team that features physicians who are board-certified in the treatment of heart failure.

INTEGRIS Health Heart Hospital has expanded to help serve the ongoing demands of heart failure and other heart-related health problems. The hospital features 64 ICU beds, multiple cardiac catheterization labs, cardiovascular operating rooms, hybrid operating rooms, electrophysiology heart labs and convenient cardiac diagnostic testing areas.