American College of Cardiology (ACC) and the American Heart Association (AHA) heart failure staging system

Last reviewed 01/2018

A shortcoming of NYHA classification is that patients may fluctuate in and out of the varying functional classes. To avoid this limitation the ACC and AHA has proposed a new staging system which emphasises on both the development and progression of the disease in stages while complementing the existing NYHA scale (1)

• stage A (no correlation with NYHA classes)
  • is at high risk for developing heart failure
  • no identified structural or functional abnormality e.g. - hypertension, coronary artery disease, diabetes, cardiotoxic medication o no signs or symptoms
    
    
• stage B (correlate best with NYHA Class I)
  • developed structural heart disease that is strongly associated with the development of heart failure e.g. - LV hypertrophy and/or impaired LV function, asymptomatic valvular heart disease
  • no signs or symptoms
    
    
• stage C (correlate best with NYHA Class II & III)
  • symptomatic (prior or current) heart failure associated with underlying structural heart disease
    
    
• stage D (correlate best with NYHA Class IV)
  
  • advanced structural heart disease and marked symptoms of heart failure at rest despite maximal medical therapy (1,2,3)

Reference:

• 1. Morris SA, Van Swol M, Udani B. The less familiar side of heart failure: symptomatic diastolic dysfunction. J Fam Pract. 2005;54(6):501-11
• 2. European Society of Cardiology (ESC) 2008. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
• 3. Jessup M et al. 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. 2009;119(14):1977-2016