Stages of Heart Failure: What to Expect as Heart Failure Progresses

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Much like cancer, Alzheimer's, COPD, and other progressive diseases, heart failure (sometimes called congestive heart failure) is staged according to the extent of damage already done -- in this case, to the heart. The doctor performs staging based on specific tests that assess the size, structure, and strength of the heart and the volume of blood it's able to pump.

Stage A

This stage is also called pre-heart failure. It suggests that there's a high risk of developing heart failure, but the heart hasn't suffered any structural damage yet, according to the tests that were performed.

What it means: As a caregiver, knowing and understanding the stage of your loved one's heart failure will help you understand the lifestyle changes and treatment the medical team recommends and what they expect in terms of management and improvement or progression. A diagnosis of Stage A heart failure tells the doctor that your loved one has danger signs for developing heart failure, so she's going to base her treatment recommendations on controlling those underlying problems. Together you'll be taking important steps to bring your loved one's blood pressure and cholesterol levels under control, treat coronary artery disease (CAD), and reduce other risk factors such as smoking and being overweight.

What to ask the doctor: What can we do to prevent heart failure symptoms from developing? How will we know treatment is working?

Stage B

Tests reveal structural damage to the heart, but the person you're caring for isn't experiencing symptoms.

What it means: Your loved one's heart has been damaged by cardiovascular problems, but he or she is lucky and hasn't yet begun to experience symptoms. With aggressive treatment to control the underlying issues, it may be possible to prevent heart failure from progressing or to keep progression as slow as possible. As a caregiver, your concern will be how to encourage your loved one to make lifestyle changes and treat underlying heart health problems, such as hypertension and coronary artery disease, so he or she doesn't develop symptoms.

What to ask the doctor: How will we know if treatment is working? What should I watch for in terms of early heart failure symptoms?

Stage C

Tests reveal structural damage, and the person you're caring for is experiencing mild to moderate symptoms.

What it means: The symptoms your loved one is experiencing are caused by heart failure, but they're in the mild to moderate range right now. Don't be discouraged if Stage C sounds advanced; keep in mind that Stage A is pre-heart failure. Many heart failure patients, with good treatment and symptom management, surprise everyone -- including themselves -- by reducing their symptoms and regaining quality of life. What you'll focus on at this stage is managing your loved one's treatment to relieve symptoms, prevent ongoing damage to the heart muscle, and -- with the right medications --even reverse some of the damage.

What to ask the doctor: What are your expectations for treatment and for reducing my loved one's symptoms? (Once you know what the doctor hopes your loved one will gain from treatment, you can set a goal for yourself to beat those expectations.)

Stage D

There's significant structural damage, and your loved one's symptoms are severe.

What it means: As you already know, the person you're caring for has been experiencing symptoms that are significantly interfering with his or her daily life. The good news is that now that you have a diagnosis, the medical team will put together a treatment plan designed to help your loved one be more comfortable. It's also possible that with adequate treatment, heart failure symptoms can be controlled enough that he or she can regain some strength and become more active. However, at this stage hospitalization may be necessary if your loved one's symptoms worsen, so it's important to know the danger signs that should trigger a call to the doctor or trip to the ER.

What to ask the doctor: Be sure you have everything you need to fully understand all the doctor's treatment goals and instructions. If you'll be managing your loved one's treatment, you're in the hot seat, so don't be shy about asking all the questions you need to. Make especially sure you have a list of all medications, the dosage schedule, and any side effects to watch for.

If the doctor has recommended additional tests, specialists to see, or programs such as cardiac rehabilitation, make sure you know what they are and what to do next to schedule or access them. If your family member is going to have advanced therapies, such as a left ventricular assist device (LVAD) or intravenous medication delivered continuously by a pump worn at home, make sure you know how the therapy works and what's required for home use.

Everyone's different, but at this stage some caregivers want to know what to expect down the line. If you prefer to be able to look ahead and prepare, tell the doctor that and ask her to "give it to you straight" in terms of your loved one's prognosis.

Note: This stage used to be called "end stage" and you may still hear this term used, but it's no longer in favor because new treatment options are making it possible for many people to live a long time with good quality of life with Stage D heart failure.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio