Which Stage of Heart Failure Am I In?
How can you determine what stage of heart failure you are in and since you can improve, why have stages?
The stages of heart failure are determined by how much shortness of breath you have, related to the amount of activity you can do without symptoms. For instance, some people can completely take care of themselves, such as dressing or bathing, with minimal shortness of breath. This would be Stage 1. Or, you may be short of breath with all activity, but at rest you are comfortable, which is considered Stage 3. Stage 4, the most severe, is when you have symptoms even at rest.
We have a rating system for heart failure because as heart failure progresses, this allows the medical team to form treatment plans related to the symptoms a patient is having. As the disease progresses, symptoms worsen, so the goals of care are going to be different along the way.
It is true that some patients improve with medications and surgical treatment. However, not every patient has these options available to them. Sometimes, advanced age can limit treatment options, as can other diseases that a person may have. Every patient is different, so the goals of care must be tailored to an individual's needs.
There are two distinct approaches to heart failure:
Staging - which uses the American Heart Association's structural classification approach
Functional Class - In the USA, this generally means using the New York Functional Classifications.
Structural classifications can be useful in that we can now stage heart failure much like we stage cancer. Early stage heart failure can be treated effectively - and quantity and quality of life preserved. Additionally, staging permits the early identification of risk factors for heart failure - and can be used in a preventative manner.
Functional Classification implies that sympotms are already present - further implying that irreversible structural changes are also present. Functional classifications change as does the physiology ofthe person afflicted with heart failure. Functional classifications help the doctor think through treatment options - which are expanding every day.
Both approaches offer us insight into understanding the disease process in a partiucalr individual - and designing an approach to care for that human person.
Tony Joseph, MD - http://www.thacinc.com
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