ACC and AHA Heart Failure Classification

Study Notes

ACC and AHA Classification of Heart Failure

Stage A
- High risk for developing left ventricular dysfunction without structural heart disease or heart failure (HF) symptoms.
- Patient characteristics: Hypertension (HTN), atherosclerotic disease, diabetes mellitus (DM), metabolic syndrome.
- Treatment involves promoting a heart-healthy lifestyle.
- Risk factors include HTN, elevated lipids, DM, and obesity.
Stage B
- Characterized by left ventricular dysfunction or structural heart disease without HF symptoms.
- Patient history may include myocardial infarction (MI), left ventricular hypertrophy, and low ejection fraction (EF).
- Treatment includes Stage A interventions, plus the use of ACE inhibitors or ARBs for low EF or history of MI.
- Beta blockers and statins are also recommended.
Stage C
- Patients present with left ventricular dysfunction or structural heart disease and current or past symptoms of heart disease.
- Common symptoms include shortness of breath (SOB), fatigue, and decreased exercise tolerance.
- Management expands to include Stage A and B treatments, in addition to diuretics, aldosterone antagonists, sodium restriction, and possibly an implantable defibrillator or cardiac resynchronization therapy.
Stage D
- Represents refractory end-stage heart failure requiring specialized interventions.
- Patients experience symptoms despite maximal medical therapy and have recurrent hospitalizations.
- Treatment plan includes all interventions from Stage A, B, and C, along with fluid restrictions, end-of-life care, and extraordinary measures.
- Options may include inotropes, cardiac transplantation, and mechanical support.