Heart Failure Stages

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In early heart failure stages, the disease is most curable. If the disease progresses to later stages, treatment shifts to slowing progression and easing symptoms. There are four stages of heart failure ranging from symptomless to shortness of breath even while resting and other symptoms.

If you’re heart isn’t pumping enough oxygen-rich blood, you may develop shortness of breath as your lungs try to capture more oxygen. Your lower limbs may swell as blood isn’t pushed through the heart efficiently, and fluid backs up. You may feel angina — chest pain or discomfort — because the heart itself isn’t being replenished with oxygen.

The heart failure stages are marked by the severity of symptoms and, each stage has specific treatment options.

Understanding the 4 Heart Failure Stages

The Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program’s team of board-certified and fellowship-trained physicians and advanced practice providers has the experience and expertise to diagnose the progress of your heart failure and provide a comprehensive range of treatment.

Our goal will be to halt, slow or even reverse the progression of your heart failure and improve your quality of life. For some, heart failure can be reversed, with the heart muscle returning to a healthy structure and resuming effective pumping.

Stage A

At this point you are at high risk for heart failure, but you don’t have any symptoms and the structure of your heart hasn’t changed.

Risks include a family history of heart failure or conditions such as hypertension (high blood pressure), diabetes, rheumatic fever, alcohol abuse or medications that can damage the heart muscle.

Treatment options

  • Lifestyle adjustments, including daily exercise
  • Smoking cessation
  • Treatment for high blood pressure and high cholesterol
  • Medications
    • ACE inhibitors or angiotensin II receptor blockers (ARBs)
    • Statins

Stage B

At this heart failure stage, you may have mild shortness of breath and/or angina. This usually will be revealed in an echocardiogram that shows a weakened left ventricle that pumps about 40% or less of the blood in your heart. The measure, called ejection fraction, is normally about 55% or higher.

Treatment options

  • Lifestyle adjustments: exercise, stop smoking
  • ACE inhibitors or angiotensin II receptor blockers (ARBs)
  • Beta blockers
  • Remote, wireless monitor for subtle changes to internal volume status (CardioMEMS)
  • Implanted cardioverter defibrillator
  • Wearable cardioverter defibrillator (LifeVest)
  • Revascularization or valve surgery as appropriate

Stage C

At this stage, your activity has been severely limited by symptoms such as wheezing, fatigue, nausea, increased nighttime urination, shortness of breath, swollen legs, ankles and feet. 

Treatment options

  • Pre-heart failure treatments
  • Diuretics to reduce fluid retention
  • ACE inhibitors or angiotensin II receptor blockers (ARBs)
  • Beta blocker
  • Aldosterone antagonist
  • Revascularization or valve surgery
  • Cardiac resynchronization therapy (CRT)
  • Implanted cardioverter defibrillator
  • Wearable cardioverter defibrillator (LifeVest)
  • Remote, wireless monitor for subtle changes to internal volume status (CardioMEMS)

Stage D

At this stage of heart failure, you are very limited in movement and spend large amounts of time in bed. At this point, you have undergone recurrent hospitalizations despite medical treatment.

Treatment options

Heart Failure Classification

  • Systolic heart failure (reduced ejection fraction, or HFrEF): The left ventricle has weakened, possibly because it has become enlarged and can’t contract properly. Your heart is pumping out 35% to 40% or less of the blood it holds. Normal is about 55%.
  • Heart failure with mildly reduced ejection fraction (HFmrEF): This describes an estimated 10% to 25% of heart failure patients. The ejection fraction isn’t up to normal, but isn’t low enough to be systolic heart failure. It has different risks of complications, and you may have a different course of treatment compared with the reduced ejection fraction or the preserved ejection fraction classifications.
  • Diastolic heart failure (preserved ejection fraction, or HFpEF): You have the symptoms of heart failure, but the ejection fraction is normal. This is a sign that the left ventricle isn’t filling properly with blood, even though it pumps a normal percentage of what it receives. The result is less blood pumped through the body.

Early Stages of Heart Failure

Heart failure can strike anyone at any age. African Americans are more likely to develop heart failure at a younger age and with greater severity than other groups.

Monitoring your blood pressure and adopting healthy lifestyle habits, including quitting smoking, are some of the steps you can take to reduce your chances of developing heart failure.

In its early stages, heart failure can have the following symptoms. If you have any of these symptoms, you may or may not be developing heart failure. Discuss your symptoms with your primary care provider.

  • Fatigue: Tired and lacking energy.
  • Chest congestion: A buildup of fluid in the lungs can cause you to cough and wheeze.
  • Swelling: Another sign of fluid buildup is swelling in the feet, ankles and lower legs. Because the heart isn’t pumping as well as it needs too, moving fluid from the lower extremities is difficult.
  • Shortness of breath: Fluid in the lungs and difficulty getting oxygen out to the body can leave you trying to catch your breath.
  • Limited activity: You can’t do everything you used to because you get tired or have trouble catching your breath.

Advanced Heart Failure

In cases where other treatments have failed and symptoms have left you unable to perform daily tasks, we have treatments that can restore much of your quality of life. Advanced heart failure used to be called “end-stage heart failure,” but such a label doesn’t reflect the reason for hope with new treatments.

More aggressive medication, ventricular assist devices or heart transplant are ways to slow the progress of advanced heart failure and alleviate symptoms.

In addition to the common symptoms of heart failure, the condition is considered advanced when medication and other treatments improve symptoms.

Characteristics of advanced heart failure include:

  • More than two hospital stays or emergency room visits for heart failure in a year
  • Unexplained weight loss
  • Intolerance to ACE inhibitors or beta blockers
  • Dressing or bathing persistently requires rest and causes shortness of breath
  • Unable to walk about 100 yards on level ground without fatigue or shortness of breath
  • Frequent shocks by a cardioverter-defibrillator

If you have advanced heart failure, the range of treatments to slow the progress of your disease is expanding rapidly.

The Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program offers a new way to look at the management of heart failure. Treatment options for advanced heart failure include:

  • Myocardial Recovery Program designed — through a combination of therapies — to rebuild the heart muscle and recover to normal heart function
  • Heart failure medication management — through close monitoring paired with a combination of medication therapy to help the heart pump more blood
  • Ventricular assist device — either as a permanent treatment or a bridge to a heart transplant
  • Heart transplant– As a member of the UK Gill Heart & Vascular Institute Affiliate Network, our providers work closely with the UK HealthCare heart transplant providers to walk each patient through evaluation, testing and the organ transplantation process.

Frequently Asked Questions

What Are the 4 Stages of Heart Failure

Heart failure can start with no symptoms, but a risk of developing the disease. The structure of the heart hasn’t changed — a thickened heart muscle, for instance. At this point, the primary treatment is to reduce risk with lifestyle changes and treating conditions such as high blood pressure that may be contributing to the risk.
If heart.failure advances, heart failure symptoms develop or worsen. Treatment needs to get more aggressive with each stage.

What Stage of Heart Failure Is Shortness of Breath

Shortness of breath typically starts with stage B heart failure. Angina –— chest pain — also may develop as oxygen levels feeding the heart decline.
Treatment shortly after symptoms start offers the best chance of curing and reversing heart failure. In cases where heart failure was diagnosed early and wasn’t accompanied by heart attack or other heart disease, Norton Heart & Vascular Institute has cured about 50% of cases. That compares with a national benchmark of 10%.

How Long Does the End Stage of Heart Failure Last

People are living longer with end-stage, or advanced heart failure, than ever before. Advances in medication and use of devices such as ventricular assist devices has allowed more and more patients to live better lives with improved symptoms.

Can Early Stages of Heart Failure Be Reversed

Yes. Medication regimens used at the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program can cure the disease, reversing its effects, if diagnosed early and shortly after symptoms start.

Stages of Heart Failure Life Expectancy

Life expectancy for all stages of heart failure has improved in recent years as more patients work with specialists who monitor their condition closely and take steps to correct situations, often before the patient even notices a change. At the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program, we’ll work to catch the slightest sign of deteriorating symptoms to prevent your condition worsening to the point that you need to spend time in the hospital.

What Is Early Heart Failure?

The first signs of heart failure can include shortness of breath, swelling in the feet, ankles and lower legs, chest congestion, and fatigue.

How Quickly Does Heart Failure Progress?

Left untreated, heart failure can progress rapidly over the course of weeks or months. However, early treatment can cure the disease, even in those whose disease has progressed. For those with more advanced disease, life expectancy has been steadily improving, with newer treatments leading to more recovery.

Heart Failure Care Designed for Heart Recovery

  • Same-day appointments are available for new patients at locations in downtown Louisville and on the campuses of Norton Audubon Hospital and Norton Brownsboro Hospital.
  • Our compassionate and dedicated team includes specially trained heart failure cardiologists and advanced practice providers, a social worker, nurse navigators and dedicated pharmacist to help create a custom plan for care and make sure you and your family’s questions are answered at every step.
  • When diagnosed promptly, more than 50% of patients with heart failure that wasn’t caused by heart attacks or blockages are cured, compared with about 10% nationally.
  • Our program has advanced heart failure monitoring technology to detect signs of a weakening heart before you feel symptoms, with a goal of preventing hospital stays.
  • We are a DNV-accredited provider of ventricular assist devices and are recognized as High Performing in Heart Failure by U.S. News & World Report.
  • Our advanced care for severe heart failure includes ventricular assist device implants, extracorporeal membrane oxygenation (ECMO) support to give your heart a rest and time to heal, and access to heart transplants with ongoing aftercare.
  • Medicare, Medicaid and most major commercial insurance plans are accepted.
  • Book appointments, get alerts when an earlier appointment becomes available, communicate with your medical provider, refill prescriptions and more through your free Norton MyChart account.

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