ACC AHA Heart Failure Staging

Determines the heart failure stage and treatment recommendations based on patient clinical data.

Refer to the text below the calculator for more information about the four stages of heart failure by the ACC AHA classification.


This staging system for heart failure was developed jointly by the American College of Cardiology (ACC) and American Heart Association (AHA) by expert consensus.

Whilst originally meant to complement the more widely-used New York Heart Association (NYHA) functional classification, they provide contemporary treatment recommendations that vary by stage.


ACC/AHA HF staging
Stage A: High risk for developing HF but no structural disorder of the heart
Stage B: Structural disorder of the heart but has never developed symptoms of HF
Stage C: Past or current symptoms of HF associated with underlying structural heart disease
Stage D: End-stage disease requiring specialized treatment strategies

1Patient with history of hypertension, coronary artery disease, OR diabetes
2Patient using cardiotoxins
3Patient with family history of cardiomyopathy
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ACC/AHA Heart Failure Staging Explained

This staging system for heart failure was developed jointly by the American College of Cardiology (ACC) and American Heart Association (AHA) by expert consensus.

Whilst originally meant to complement the more widely-used New York Heart Association (NYHA) functional classification, they provide contemporary treatment recommendations that vary by stage.

The staging may be used for patient already diagnosed with HF but also with patients at risk of developing heart failure.

ACC/AHA HF staging Treatment recommendations
Stage A: High risk for developing HF but no structural disorder of the heart · Control of systolic and diastolic hypertension in accordance with recommended guidelines. (Level of Evidence: A)
· Treatment of lipid disorders in accordance with recommended guidelines. (Level of Evidence: B)
· Avoidance of patient behaviors that may increase the risk of HF (e.g., smoking, alcohol consumption, and illicit drug use). (Level of Evidence: C)
· Angiotensin converting enzyme (ACE) inhibition in patients with a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension and associated cardiovascular risk factors. (Level of Evidence: B)
· Control of ventricular rate in patients with supraventricular tachyarrhythmias. (Level of Evidence: B)
· Treatment of thyroid disorders. (Level of Evidence: C)
· Periodic evaluation for signs and symptoms of HF. (Level of Evidence: C)
Stage B: Structural disorder of the heart but has never developed symptoms of HF · ACE inhibition in patients with a recent or remote history of myocardial infarction regardless of ejection fraction. (Level of Evidence: A)
· ACE inhibition in patients with a reduced ejection fraction, whether or not they have experienced a myocardial infarction. (Level of Evidence: B)
· Beta-blockade in patients with a recent myocardial infarction regardless of ejection fraction. (Level of Evidence: A)
· Beta-blockade in patients with a reduced ejection fraction, whether or not they have experienced a myocardial infarction. (Level of Evidence: B)
· Valve replacement or repair for patients with hemodynamically significant valvular stenosis or regurgitation. (Level of Evidence: B)
· Regular evaluation for signs and symptoms of HF. (Level of Evidence: C)
· Measures listed as class I recommendations for patients in stage A. (Levels of Evidence: A, B, and C as appropriate).
Stage C: Past or current symptoms of HF associated with underlying structural heart disease · Diuretics in patients who have evidence of fluid retention. (Level of Evidence: A)
· ACE inhibition in all patients unless contraindicated. (Level of Evidence: A)
· Beta-adrenergic blockade in all stable patients unless contraindicated. Patients should have no or minimal evidence of fluid retention and should not have required treatment recently with an intravenous positive inotropic agent. (Level of Evidence: A)
· Digitalis for the treatment of symptoms of HF, unless contraindicated. (Level of Evidence: A)
· Withdrawal of drugs known to adversely affect the clinical status of patients (e.g., nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs). (Level of Evidence: B)
· Measures listed as class I recommendations for patients in stages A and B (Levels of Evidence: A, B, and C as appropriate).
Stage D: End-stage disease requiring specialized treatment strategies · Meticulous identification and control of fluid retention. (Level of Evidence: B)
· Referral for cardiac transplantation in eligible patients. (Level of Evidence: B)
· Referral to an HF program with expertise in the management of refractory HF. (Level of Evidence: A)
· Measures listed as class I recommendations for patients in stages A, B, and C. (Levels of Evidence: A, B, and C as appropriate).
 

References

Original reference

Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001; 38(7):2101-2113.

Other references

Hunt SA, Abraham WT, Chin MH, et al. 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. 2005; 112(12):e154-e235.


Specialty: Cardiology

System: Staging

Year Of Study: 2001

Abbreviation: ACC/AHA

Article By: Denise Nedea

Published On: September 2, 2020

Last Checked: September 2, 2020

Next Review: September 2, 2025