The Stages Of Congestive Heart Failure

If you have been diagnosed with heart failure by your doctor the next steps will be to evaluate the stage that you are in.  The most commonly used classification systems is the New York Heart Association Functional Classification.  This system offers 2 different classes which combined will determine which stage of congestive heart failure the patient is in.

The 2 Classes

The first class of stages called the function capacity relates to the symptoms that the patient is experiencing.  These symptoms are based on the limitations that disease has placed on the patient during physical activity.  The more severe the limitations are, the higher the classification.

The second class of stages is an objective assessment related more to the evidence of cardiovascular disease.  There are 4 stages in the classification with the higher classes being for patients that exhibit cardiovascular disease.  This classification is generally completed after the functional capacity assessment.

Functional Capacity Stages

The first set of stages that are assessed will be the functional capacity.  There are 4 stages labeled 1 to 4, each with different criteria.  The criteria are based on physical activity limitations.

  • Stage I is classed as no limitations on the patient’s physical activity. This means that ordinary activity can be undertaken without heart palpitations, fatigue or shortness of breath.
  • Stage II is classed as slight limitations to physical activity. However, the patient will be comfortable during rest times.  Ordinary activities for people in this stage will result in fatigue, shortness of breath and palpitations.
  • Stage III is classed as having marked limitations on the physical activity of the patient. However, the patient will still be comfortable during rest times.  Activity which is less than ‘ordinary’ will cause fatigue, palpitation and shortness of breath for people in this stage.
  • Stage IV is the last stage and classed as being unable to complete any physical activity without some form of discomfort. There will also be symptoms of heart failure during rest times.  Any physical activity will result in increased discomfort.

Objective Assessment Stages


As with functional capacity there are 4 stages in this classification.  The stages are labelled A to D to eradicate confusion during diagnosis.

  • Stage A is classed as there being no objective evidence of a patient having cardiovascular disease. There are no heart failure symptoms and no limitations during ordinary activities.
  • Stage B is classes as there being evidence of minimal heart disease. There are generally mild symptoms and slight limitations during activity.  The patient will be comfortable during rest times.
  • Stage C is used for patients with evidence of moderate cardiovascular disease. People in this stage will also have marked limitations during physical activities and during less than ordinary activity.  Stage C patients will only be comfortable during rest times.
  • Stage D is classed as there being evidence of severe heart disease. There will be severe limitations during activity and heart failure systems will persist during times of rest.

When heart failure is diagnosed the 2 different classifications are combined to give the best description of a patient’s situation.  This means that a patient with no systems of during physical activity, but with pressure in the heart will be classed as Functional Capacity I, Objective Assessment D.  This double classification ensures that the best treatments are found for patients.