Degrees of heart failure

Heart failure (HF) is classified into four stages, depending on the severity and symptoms. This classification helps doctors and patients to determine how advanced the disease is and to choose the appropriate treatment. The following classification system is commonly used.

NYHA classification system

1. Stage I heart failure (NYHA I): In this stage, patients do not experience symptoms of heart failure at rest and can perform normal physical activities without discomfort. This may be referred to as "compensated" CH, when the heart is able to provide normal blood flow with minimal exertion.
2. Stage II heart failure (NYHA II): In this stage, patients may experience slight shortness of breath, fatigue, and discomfort with normal physical activity, but they are able to perform normal daily activities without much restriction.
3. Stage III heart failure (NYHA III): Patients in this stage experience severe heart failure symptoms such as increased shortness of breath, fatigue, and discomfort with even minor physical activity. They may experience limitations in their ability to perform normal activities.
4. Stage IV heart failure (NYHA IV): This stage is characterized by severe symptoms even at rest. Patients may experience shortness of breath and fatigue even with minor physical exertion. The heart is unable to provide adequate blood supply to organs and tissues, which can lead to acute heart failure and require urgent medical attention.

These stages of heart failure can be determined by a doctor after evaluating symptoms and the results of specialized tests such as echocardiography and ejection fraction tests. Treatment and management of heart failure will depend on the severity, cause and overall condition of the patient. It is important to follow the doctor's recommendations and be seen regularly by a specialist to effectively monitor and treat this condition.

ACC/AHA classification system

Stage A:

• Risk of developing heart failure, but without symptoms or structural changes in the heart.

Stage B:

• Structural changes in the heart (e.g., enlargement of the left ventricle) but without symptoms of CH.

Stage C:

• Symptoms of CH during normal physical activity.

Stage D:

• SN symptoms with minimal physical activity or even at rest.

Note that the NYHA classification system focuses on functional symptoms, whereas the ACC/AHA classification system takes into account structural changes in the heart. Assessing stage and functional class helps the physician determine the best treatment and monitoring plan for the patient with CH.

The NYHA classification helps to assess physical activity and discomfort levels in patients with heart failure, as well as determine severity and monitor it during treatment. Here are some additional aspects related to the degrees of heart failure:

1. Heart failure with preserved ejection fraction (HFpEF): This is a form of heart failure in which the heart's ejection fraction (EF) remains normal, but patients may have symptoms associated with impaired relaxation of the heart ventricles. The NYHA classification can also be used to assess the severity of this form of heart failure.
2. Heart failure with reduced ejection fraction (HFrEF): This is a more common form of heart failure in which the ejection fraction is reduced. In patients with HFrEF, the NYHA classification can also be useful in determining severity and treatment selection.
3. Heart failure with comorbid conditions: In some patients, heart failure may be accompanied by other chronic conditions such as diabetes mellitus, chronic obstructive pulmonary disease (COPD), arterial hypertension, and others. These conditions can also affect the severity of heart failure and the treatment approach.
4. Individualized treatment: Treatment of heart failure often involves a combination of medications, exercise, diet and other interventions that must be tailored to each patient's individual needs. The choice of treatment also depends on the severity, form and causes of heart failure.

Regardless of the degree of heart failure, regular medical monitoring and adherence to doctor's recommendations play a key role in managing this condition and improving the patient's quality of life.

Terminal heart failure

This is an extremely severe and advanced form of heart disease in which the heart is unable to reliably supply the body with blood and oxygen. This condition is characterized by serious symptoms and frequent hospitalizations, and it can be life-threatening.

The main characteristics of terminal heart failure include:

1. Serious symptoms: Patients with end-stage heart failure experience severe fatigue, shortness of breath, swelling (e.g., leg and lung swelling), chest pain, and decreased ability to exercise. They often experience shortness of breath even at rest.
2. Frequent hospitalizations: Patients with terminal heart failure often require hospitalization due to exacerbations of their condition, life-threatening arrhythmias, and other serious complications.
3. Limited vitality: Patients may have a limited ability to perform normal daily activities due to severe symptoms. Quality of life is reduced.
4. Limited treatment options: In this stage, treatment measures such as drug therapy or surgery may be limited. In some patients, more radical treatment such as heart transplantation or implantation of a mechanical pump to maintain cardiac function may be considered.
5. High risk of death: Patients with terminal heart failure have a high risk of death, especially if effective treatment measures are not taken.

Treatment of terminal heart failure may include palliative measures to relieve symptoms and improve quality of life, as well as interventions to manage complications. In some patients, heart transplantation or other surgical interventions may be considered as a last hope for saving life.

It is important to emphasize that terminal heart failure requires a comprehensive and individualized approach to treatment and patient care, and treatment decisions should be made in conjunction with cardiologists and other health care professionals.

Stages of heart failure according to Strzesko

The stages of heart failure can be classified according to a classification system developed by John J. Straznicky, which takes into account both structural changes in the heart and clinical symptoms. Here are the stages of heart failure according to the Straznicky classification system:

1. Phase I (Initial Phase):

   • Structural changes: There are no structural changes in the heart.
   • Clinical symptoms: Absence of symptoms or subjective complaints that cannot be definitively associated with heart failure.

2. Phase II (Clinical Phase):

   • Structural changes: There may be structural changes of the heart such as ventricular enlargement or myocardial atropy, but not yet abnormalities of cardiac pump function.
   • Clinical symptoms: Appearance of clinical symptoms associated with heart failure such as dyspnea, fatigue, edema and others.

3. Stage III (Aggravated Stage):

   • Structural changes: Progressive structural changes of the heart and impaired heart function.
   • Clinical symptoms: Severe symptoms of heart failure that limit normal daily activities.

4. Phase IV (Terminal Phase):

   • Structural changes: Severe structural changes of the heart and severe reduction in heart function.
   • Clinical symptoms: Severe heart failure that requires specialized medical interventions, including sometimes heart transplantation or other radical treatments.

It is important to realize that the stages of heart failure according to the Strazhesko classification are used to assess the severity of the disease and choose the optimal treatment strategy.

Prognosis of survival in heart failure

Can vary significantly depending on various factors, including disease severity, patient age, presence of comorbidities, and quality of care. Below is a general overview of survival prognosis for different degrees of heart failure:

1. Stage I heart failure (NYHA I): In this stage, patients usually have a good survival prognosis as they do not experience significant symptoms and can lead a normal life with minimal limitations. With proper care and adherence to doctor's recommendations, the prognosis is usually favorable.
2. Stage II heart failure (NYHA II): Patients in this stage also have a good prognosis, but may experience minor symptoms such as shortness of breath and fatigue with exercise. With proper treatment and disease management, survival prognosis remains favorable.
3. Stage III heart failure (NYHA III): In this stage, patients experience more severe heart failure symptoms and may have limitations in physical activity. Survival prognosis remains good with adequate treatment, but more intensive disease management is required.
4. Stage IV heart failure (NYHA IV): Patients in this stage have the most serious prognosis with the greatest limitations on physical activity and increased risk of complications. However, modern treatments, including heart transplantation and mechanical heart support, can improve the prognosis for some patients.

It is important to realize that heart failure is a chronic disease and survival prognosis may vary over time and depending on the effectiveness of treatment and the level of adherence to medical recommendations. Timely referral to a physician, adherence to treatment recommendations, a healthy lifestyle and support from medical professionals play a key role in improving survival prognosis in heart failure. Each case is different, and the specific prognosis should be established by the physician based on the patient's data.

Literature used

Shlyakhto, E. V. Cardiology : national guide / ed. By E. V. Shlyakhto. - 2nd ed. Moscow : GEOTAR-Media, 2021.

Cardiology according to Hurst. Volumes 1, 2, 3. 2023