Heart Failure Stages A to D (ACC/AHA)

What the result means

Stage A

At risk: hypertension, cardiovascular disease, obesity, diabetes, cardiotoxic exposure, a cardiomyopathy variant or family history - with NO symptoms, structural disease or biomarker abnormality.

Stage B

Pre-HF, no symptoms, with one of: structural heart disease; raised filling pressures on echo; or stage A risk factors PLUS a raised natriuretic peptide or persistently elevated troponin.

Stage C

Structural heart disease with CURRENT OR PREVIOUS symptoms.

Stage D

Advanced: symptoms that interfere with daily life, resist control, and cause recurrent hospitalizations despite guideline-directed medical therapy.

One direction

Stage C includes previous symptoms, so symptoms resolving on treatment does NOT return a patient to stage B. The staging describes disease progression, not how the patient is today.

Unlike the AF stages

The 2023 atrial fibrillation stages move in both directions. These do not, and the two are easy to reason about interchangeably and wrongly.

The 2022 addition

The biomarker route into stage B is new. A hypertensive patient with a structurally normal heart and a raised natriuretic peptide is stage B, not stage A.