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==Overview==
==Overview==
There are several classification schemes used to characterize the types of heart failure (systolic or diastolic), to assess the severity (NY Heart Association Class) and the stage congestive heart failure (AHA Class A,B,C,D).
[[LVEF]] has an important role in the classification of [[patients]] with [[HF]] because of differing prognosis and response to treatments. In the guideline of 2022 [[AHA]], [[HFrEF]] is defined as [[LVEF]] ≤40% . [[HF]] with preserved [[EF]] ([[HFpEF]]) including approximately 50% of the population with [[HF]] with increased [[prevalence]]. [[HFpEF]] is defined as [[LVEF]] ≥50%. [[Heaet failure improved EF]] is considered when follow-up [[LVEF]] reaches more than 40%.


==Types of Heart Failure==
==Classification==
Patients may be broadly classified as having heart failure with depressed left ventricular ejection fraction ([[systolic dysfunction]]) or normal/preserved ejection fraction ([[diastolic dysfunction]]). Systolic and diastolic dysfunction commonly occur in conjunction with each other.
Several classification systems are used to characterize heart failure according to the: <ref name="pmid16855273">{{cite journal| author=Aurigemma GP| title= heart failure--a common and lethal condition by any name. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 3 | pages= 308-10 | pmid=16855273 | doi=10.1056/NEJMe068128 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16855273  }} </ref> <ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }}</ref>
*The pathophysiology of heart failure:
**Systolic vs diastolic heart failure
**Left-sided, right-sided or biventricular heart failure
**Low output vs high output heart failure
*The underlying physiology based on [[left ventricular ejection fraction]]:
**Heart failure with reduced [[ejection fraction]] (HFrEF), heart failure with mid-range [[ejection fraction]]  (HFmrEF), heart failure with preserved [[ejection fraction]] (HFpEF)
*The chronicity of heart failure:
**acute or chronic
*The severity of symptoms of heart failure:
**New York Heart Association Class (NYHA class)
**Killip class (severity of the symptoms in the acute setting after myocardial infarction)
*The stage (progression of the disease) of congestive heart failure:
**The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) classification: A, B, C, D.


==Assessing the Severity of Heart Failure: The New York Heart Association Criteria (NYHA)==
===1. Systolic versus Diastolic Heart Failure===
*'''Systolic Dysfunction:''' The [[left ventricular ejection fraction]] is reduced in [[systolic dysfunction]] and there is depressed contractility of the heart.
*'''Diastolic Dysfunction:''' The [[left ventricular ejection fraction]] is preserved in [[diastolic dysfunction]] and there is an abnormality in myocardial relaxation or excessive myocardial stiffness. Systolic and diastolic dysfunction commonly occur in conjunction with each other.


*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA I]]:''' No symptoms with ordinary activity.
===2. Left-, Right- and Biventricular Failure===
Another common method of classifying heart failure is based upon the ventricle involved.
*'''Left-ventricular Heart Failure:''' There is impaired left ventricular function with the reduced flow into the aorta.
*'''Right-ventricular Heart Failure:''' There is impaired right ventricular function with the reduced flow into the pulmonary artery and lungs.
*'''Biventricular Failure:''' The most common cause of right heart failure is left heart failure, and mixed presentations are common, especially when the cardiac septum is involved.


*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA II]]:''' Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in [[fatigue]], [[palpitation]], [[dyspnea]], or [[angina]].
===3. High output versus Low output Heart Failure===
*'''Low Output Failure:''' The [[cardiac output]] is reduced, and the [[systemic vascular resistance]] ([[SVR]]) is high.  In low output failure, there is an inadequate supply of blood flow to meet normal metabolic demands.
*'''High Output Failure:''' The [[cardiac output]] is increased, and the [[systemic vascular resistance]] ([[SVR]]) is low.  Rather than an inadequate supply of blood flow to meet normal metabolic demands as occurs in low output failure, in high output failure there is an excess requirement for oxygen and nutrients and the demand outstrips what the heart can provide.<ref>{{DorlandsDict|nine/000953450|high-output heart failure}}</ref> Causes of high output heart failure include severe [[anemia]], Gram negative [[septicaemia]], [[beriberi]] (vitamin B<sub>1</sub>/thiamine deficiency), [[thyrotoxicosis]], [[Paget's disease of bone|Paget's disease]], [[arteriovenous fistula]]e, or [[arteriovenous malformation]]s.


*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA III]]:''' Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in [[fatigue]], [[palpitation]], [[dyspnea]], or [[chest pain|anginal pain]].
===4.  Classification of Heart Failure Based on the Ejection Fraction (EF)===
* [[HFrEF]] is defined as [[LVEF]] <_40% or significant reduction in [[LV systolic function]].
* [[ HFmrEF]] is defined when [[LVEF]] is between 41% and 49% or there is  mildly reduced [[LV systolic function]].
* [[HF p EF]] is defined as [[LVEF]] >_50%, with [[symptoms]] and [[signs]] of [[heart failure]] , with evidence of structural and/or functional [[cardiac]] abnormalities and/or high level of  [[natriuretic peptides]] ([[NPs]]).


*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA IV]]:''' Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.
<span style="font-size:85%">'''Abbreviations:'''
'''HF:''' [[Heart failure]];
'''HFmrEF:''' [[ Heart failure with mildly reduced ejection fraction]];
'''HFpEF:'''  Heart failure with preserved ejection fraction ;
'''HFrEF:''' [[ Heart failure with reduced ejection fraction]];
'''LV:''' [[Left ventricle]];
'''LVEF:''' [[Left ventricular ejection fraction]];
</span>
{| style="border: 2px solid #4479BA; align="left"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|HFrEF}}
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|HFmrEF}}
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|HFpEF}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Symptoms]]± [[Signs]], [[LVEF]] ≤ 40%
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Symptoms]]± [[Signs]], [[LVEF]] ≥ 41%-49%
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Symptoms]]± [[Signs]], [[LVEF]]≥ 50%, cardiac structure and function abnormalities,
[[LV]] [[diastolic dysfunction]], high [[LV filling pressures]], high [[natriuretic peptides]]
|-
|}
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2021 ESC Guideline
|-
|}<ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref>
<br>
{| class="wikitable"
| colspan="2" align="center" style="background: #4479BA; color: #FFFFFF " |'''Classification of heart failure by LVEF'''
|-
| align="center" |'''Type of heart failure according to LVEF'''
| align="center" |'''Criteria'''
|-
| [[HFrEF]] ([[heart failure with reduced EF]])
| [[LVEF]] ≤ 40%
|-
|[[HFimpEF]] ( [[heart failure with improved EF]])
|
Previous [[LVEF]] ≤ 40% and a follow-up measurement of [[LVEF]]>40%
|-
| [[HFmrEF]] ([[heart failure]] with mildly reduced [[EF]])  
|
*[[LVEF]] 41%-49%
* Evidence of increased [[LV]] [[filling pressure]] (elevated [[natriuretic peptide]], non-invasive and invasive [[hemodynamic]] measurement)
|-
|[[HFpEF]] ([[heart failure with preserved EF]])
|
*[[LVEF]]≥ 50%
*Evidence of increased [[LV]] [[filling pressure]] (elevated [[natriuretic peptide]], non-invasive and invasive [[hemodynamic]] measurement)
|}
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2022 AHA Guideline
|-
|}<ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref>


==ACC/AHA Classification of Chronic Heart Failure==
===5. Chronicity of Heart Failure===
*'''Acute or Decompensated:''' Acute or decompensated heart failure is a term used to describe exacerbated or decompensated heart failure, and refers to an episode in which a patient sustains a change in heart failure signs and symptoms that necessitates urgent therapy or hospitalization.<ref name="Jessup2009">Jessup. M, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. Circulation. 2009 Apr 14;119(14):1977-2016. PMID 19324967</ref>
*'''Chronic:''' There is stable symptomatology in chronic heart failure.


==== Classification System based on structural and symptomatic stages of the syndrome. ====
===6. The Severity of Heart Failure===  
Introduced to emphasize the natural history of the heart failure syndrome and to identify ealier opportunities to intervene and prevent advancement.  (Use along with NYHA starting when symptoms develop (Stages C-D).
The NYHA functional classification is used to describe the severity of symptoms and exercise intolerance in patients with congestive heart failure.
Stage A: patients at risk of developing heart failure but who have no structural heart disease at present.
Stage B: patients with structural heart disease but no symptoms.
Stage C: patients with structural heart disease and symptomatic heart failure.
Stage D: patients with severe refractory heart failure.


==== Stage A ====
{| class="wikitable"
| colspan="2" align="center" style="background: #4479BA; color: #FFFFFF " |'''The New York Heart Association Criteria (NYHA)'''
|-
| align="center" |'''NYHA Class'''
| align="center" |'''Definition'''
|-
|'''[[New York heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA I]]'''
| No symptoms with ordinary activity
|-
|'''[[New York heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA II]]'''
|
Slight limitation of physical activity.
Comfortable at rest, but ordinary physical activity results in [[fatigue]], [[palpitation]], [[dyspnea]], or [[angina]].
|-
| '''[[New York heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA III]]'''
|
Marked limitation of physical activity.
Comfortable at rest, but less than ordinary physical activity results in [[fatigue]], [[palpitation]], [[dyspnea]], or [[chest pain|anginal pain]].
|-
|'''[[New York heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA IV]]'''
| Unable to carry out any physical activity without discomfort. Symptoms are present at rest.
|}


Patients “at Risk”
===7. The  Stages of heart failure ===
The ACC/AHA classification system was introduced to emphasize the natural history of the heart failure syndrome and to identify opportunities to intervene earlier and prevent disease progression.
 
{| class="wikitable"
| colspan="4" align="center" style="background: #4479BA; color: #FFFFFF " |2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Stages of Heart Failure
|-
| align="center" |'''Stages'''
| align="center" |'''Definition'''
| align="center" |'''Example'''
| align="center" |'''Corresponding NYHA class'''
|-
|A
|
* Patients at high risk for developing HF but without structural heart disease or symptoms of heart failure or biomarkers within normal ranges.
|
* [[Hypertension]]
* [[Hypertension]]
* [[Diabetes mellitus]]
* [[Diabetes mellitus]]
* [[Coronary artery disease]]
* [[Coronary artery disease]]
* Exposure history to [[cardiac toxins]]:
* History of Exposure to [[cardiac toxins]]:
* History of [[cardiotoxic drug]] therapy.
** History of [[cardiotoxic drug]] therapy.
* History of [[alcohol abuse]].
** History of [[alcohol abuse]].
* Familial history of [[cardiomyopathy]]
* Familial history of [[cardiomyopathy]]
|None
|-
|B
|Patients without current or previous sings/ symptoms of HF but evidence of the following:
|
* Structural heart diseases.
* Increased filling pressures in the heart.
* Increased levels of Natriuretic peptide.
* Persistently elevated cardiac diagnosis with no diagnosis.
| NYHA class I
|-
|C
|Patient with past or current symptoms/ signs of HF
|The trajectory of Stage C HF:


==== Stage B ====
* New onset/ De Novo HF
 
* Resolution of symptoms  
Patients with structural heart disease, but no history of signs or symptoms of heart failure.
* Persistent HF
* [[Left ventricular hypertrophy]] ([[LVH]])
* Worsening HF
* [[fibrosis|Myocardial fibrosis]]
| NYHA classes I, II, III, and IV
* Left ventricular dilatation or dysfunction
|-
* Asymptomatic [[valvular heart disease]]
|D
* [[acute myocardial infarction|Previous myocardial infarction]]
|Profound HF symptoms.  
 
|Patients have symptoms that interfere with daily life activities. They may also have recurrent hospitalizations despite attempts to optimize guideline-directed medical therapy.
==== Stage C ====
| NYHA class IV
 
|}
Underlying structural heart disease and symptoms of [[heart failure]].
<ref name="pmid35363500" />
* [[Dyspnea]] or [[fatigue]] due to left ventricular systolic dysfunction.
* Asymptomatic patients receiving treatment for prior symptoms of [[heart failure]].
 
==== Stage D ====
 
Despite of maximal medical therapy, symptoms of heart failure at rest and advanced structural heart disease.
* Being considered for advance options including [[LVAD]] and [[heart transplantation]]
* Requiring continuous [[inotropic]] or mechanical support
* Receiving or being considered for palliative care/end of life care.
 
==Guidelines Resources==
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] ''Circulation'' 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586] PMID: [http://pubmed.gov/16160202 16160202]</ref>
 
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 12:28, 28 November 2022



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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

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Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Risk calculators and risk factors for Congestive heart failure classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2], Sara Zand, M.D.[3] Jair Basantes de la Calle, M.D.

Overview

LVEF has an important role in the classification of patients with HF because of differing prognosis and response to treatments. In the guideline of 2022 AHA, HFrEF is defined as LVEF ≤40% . HF with preserved EF (HFpEF) including approximately 50% of the population with HF with increased prevalence. HFpEF is defined as LVEF ≥50%. Heaet failure improved EF is considered when follow-up LVEF reaches more than 40%.

Classification

Several classification systems are used to characterize heart failure according to the: [1] [2]

  • The pathophysiology of heart failure:
    • Systolic vs diastolic heart failure
    • Left-sided, right-sided or biventricular heart failure
    • Low output vs high output heart failure
  • The underlying physiology based on left ventricular ejection fraction:
  • The chronicity of heart failure:
    • acute or chronic
  • The severity of symptoms of heart failure:
    • New York Heart Association Class (NYHA class)
    • Killip class (severity of the symptoms in the acute setting after myocardial infarction)
  • The stage (progression of the disease) of congestive heart failure:
    • The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) classification: A, B, C, D.

1. Systolic versus Diastolic Heart Failure

2. Left-, Right- and Biventricular Failure

Another common method of classifying heart failure is based upon the ventricle involved.

  • Left-ventricular Heart Failure: There is impaired left ventricular function with the reduced flow into the aorta.
  • Right-ventricular Heart Failure: There is impaired right ventricular function with the reduced flow into the pulmonary artery and lungs.
  • Biventricular Failure: The most common cause of right heart failure is left heart failure, and mixed presentations are common, especially when the cardiac septum is involved.

3. High output versus Low output Heart Failure

4. Classification of Heart Failure Based on the Ejection Fraction (EF)

Abbreviations: HF: Heart failure; HFmrEF: Heart failure with mildly reduced ejection fraction; HFpEF: Heart failure with preserved ejection fraction ; HFrEF: Heart failure with reduced ejection fraction; LV: Left ventricle; LVEF: Left ventricular ejection fraction;

HFrEF HFmrEF HFpEF
Symptoms± Signs, LVEF ≤ 40% Symptoms± Signs, LVEF ≥ 41%-49% Symptoms± Signs, LVEF≥ 50%, cardiac structure and function abnormalities,

LV diastolic dysfunction, high LV filling pressures, high natriuretic peptides

The above table adopted from 2021 ESC Guideline

[4]


Classification of heart failure by LVEF
Type of heart failure according to LVEF Criteria
HFrEF (heart failure with reduced EF) LVEF ≤ 40%
HFimpEF ( heart failure with improved EF)

Previous LVEF ≤ 40% and a follow-up measurement of LVEF>40%

HFmrEF (heart failure with mildly reduced EF)
HFpEF (heart failure with preserved EF)
The above table adopted from 2022 AHA Guideline

[5]

5. Chronicity of Heart Failure

  • Acute or Decompensated: Acute or decompensated heart failure is a term used to describe exacerbated or decompensated heart failure, and refers to an episode in which a patient sustains a change in heart failure signs and symptoms that necessitates urgent therapy or hospitalization.[6]
  • Chronic: There is stable symptomatology in chronic heart failure.

6. The Severity of Heart Failure

The NYHA functional classification is used to describe the severity of symptoms and exercise intolerance in patients with congestive heart failure.

The New York Heart Association Criteria (NYHA)
NYHA Class Definition
NYHA I No symptoms with ordinary activity
NYHA II

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina.

NYHA III

Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

NYHA IV Unable to carry out any physical activity without discomfort. Symptoms are present at rest.

7. The Stages of heart failure

The ACC/AHA classification system was introduced to emphasize the natural history of the heart failure syndrome and to identify opportunities to intervene earlier and prevent disease progression.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Stages of Heart Failure
Stages Definition Example Corresponding NYHA class
A
  • Patients at high risk for developing HF but without structural heart disease or symptoms of heart failure or biomarkers within normal ranges.
None
B Patients without current or previous sings/ symptoms of HF but evidence of the following:
  • Structural heart diseases.
  • Increased filling pressures in the heart.
  • Increased levels of Natriuretic peptide.
  • Persistently elevated cardiac diagnosis with no diagnosis.
NYHA class I
C Patient with past or current symptoms/ signs of HF The trajectory of Stage C HF:
  • New onset/ De Novo HF
  • Resolution of symptoms
  • Persistent HF
  • Worsening HF
NYHA classes I, II, III, and IV
D Profound HF symptoms. Patients have symptoms that interfere with daily life activities. They may also have recurrent hospitalizations despite attempts to optimize guideline-directed medical therapy. NYHA class IV

[5]

References

  1. Aurigemma GP (2006). "heart failure--a common and lethal condition by any name". N Engl J Med. 355 (3): 308–10. doi:10.1056/NEJMe068128. PMID 16855273.
  2. Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  3. Template:DorlandsDict
  4. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)
  5. 5.0 5.1 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  6. Jessup. M, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. Circulation. 2009 Apr 14;119(14):1977-2016. PMID 19324967