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

over 3 years, said...

Not helpful because, as a patient with obvious stage D, I want to know what to expect with progression of disease!

almost 4 years, said...

I have been diagnosed with progressive heart disease. What exactly should I exspect to happen?

over 4 years, said...

I've just been told my 82 year old mother has heart and renal failure as you can imagine I am very upset and very confused as to what this means. I've searched the internet for answers as to treatment and prognosis. Please can someone help?

about 5 years, said...

Examples and specifics. These were way too generalized. Each stage seem s to have the same no-information rhetoric. Pre means before, next stage means next stage, worst stage=damage. Ask the doctor what meds. That basically summarizes this article.

about 5 years, said...

Would like to know if we are ok to go on hols we always went abroad twice a year and on lots of coach tours. But now my husband has heart failure we are a bit scared to go away. I want to go for him to put him back on track to make him feel better. He's scared he spoils it for me. We keep putting it off. Can anyone give us advice

about 5 years, said...

I'm turning 48 years old next month and have been suffering from Congestive Heart Failure for the last 12 years of my life. My Ejection Fracture is between 25%-35%. I am on my second pacemaker ICD Defib. and due for a new one within the next 6-8 months. My symptoms lately have been of weight loss, low appetite. extreme tiredness and aches and pains (particularly the lower back). Are the symptoms of the last stages of CHF? What is my projected longevity estimated at this point? Any suggestions, comments or candid remarks are welcomed. Thank you.

over 5 years, said...

I would like to have known how to differentiate between these stages of heart failure and other commonly misdiagnosed diseases, and also if heart problems can show up in skin problems, fingernails or hair.

about 6 years, said...

My Husband is 73, he had the upper lobe of his left lung removed 12/13/12 because of cancer, a few hours after the surgery he had a massive heart attack,(he also had one 2/13/2000) and a day after the heart attack he had a mild stroke....the doctors did not give us much hope at the time. However my husband is home and driving again already, but he seems to be experiencing the signs of CHF, swelling and pain and shortness of breath when he lays down and he tires much more easily ...he slept all day today and then went back to bed early because he was swollen and uncomfortable...I am so worry..his next dr. appt is not til the 20th of april..what do I need to watch for and what do I need to do??? Am i going to lose my husband soon like his one doctor told me when he was in the hospital?????

over 6 years, said...

Be specific about subjective symptoms the patient might experience.