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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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)


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