Heart Failure Classifications and Stages Are Key to Treatment

How are ACC/AHA stages defined?

The American College of Cardiology and the American Heart Association (ACC/AHA) have developed a heart failure classification system for staging patients at risk for and with clinical heart failure.1

ACC/AHA stages help set treatment goals1

The ACC/AHA stages provide useful information about the development and severity of heart failure and help set treatment goals for each stage.

ACC/AHA stages help set heart failure treatment goals.

*ACEI = angiotensin-converting enzyme inhibitor; AF = atrial fibrillation; ARB = angiotensin-receptor blocker; CAD = coronary artery disease; CRT = cardiac resynchronization therapy; DM = diabetes mellitus; HF = heart failure; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; HRQOL = health-related quality of life; HTN = hypertension; ICD = implantable cardioverter-defibrillator; LV = left ventricular; MCS = mechanical circulatory support.

See ACC/AHA Guidelines and 2016 update.

NYHA classes categorize the severity of heart failure symptoms in ACC/AHA stages C and D1

To define the clinical severity of heart failure in patients with stages C and D, the New York Heart Association (NYHA) classes are widely used and accepted based on exercise capacity and symptoms of the disease.1

Risk of death increases with escalation of NYHA class. However, those in NYHA class II have a higher risk of sudden cardiac death. An analysis of 6 trials/registries comprising over 10,000 HF patients followed for a mean of 1.6 years evaluated the Seattle Heart Failure model and its relationship to NYHA class for predicting mode of death. A key finding was that sudden death accounted for 65%* of all deaths in NYHA Class II patients. In a post-hoc analysis of data from a randomized trial of nearly 4000 heart failure patients, the proportion of patients who died from heart failure increased with NYHA class.2,3

*In NYHA class II, the absolute risk of sudden death at 1 year was 4%.3


  1. Yancy CW, Jessup M, Bozkurt B, et al. 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. Circulation. 2013;128(16):e240-e327.
  2. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet.1999;353:2001-2007.
  3. Mozaffarian D, Anker SD, Anand I, et al. Prediction of mode of death in heart failure: the Seattle Heart Failure Model. Circulation. 2007;116(4):392-398.