Medically reviewed on Feb 25, 2024 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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The Centers for Disease Control (CDC) estimates some 6.2 million American adults have heart failure—though congestive heart failure is a bit different. [1]
Healthcare providers may use the term “heart failure” when the heart cannot adequately conduct blood flow to support the body. But congestive heart failure (CHF) is a progressive condition that causes a buildup of fluid, resulting in escalating physical damage and, if improperly managed, death. [2]
Fortunately, definitions and classification systems for CHF have evolved to allow more patients to receive heart failure treatment early and improve their long-term health outcomes. [3] Many wonder, what are the 4 stages of congestive heart failure?
If you’ve been diagnosed with one of the four stages of CHF, understanding how they compare is fundamental for establishing the most effective treatment in your healing.
Congestive heart failure is not a disease but a cluster of symptoms that characterize cardiac dysfunction or structural damage. [4]
People who may be at high risk for CHF typically exhibit at least one of the following biomarkers [4]:
In 2020, an assembly of healthcare professionals agreed upon what’s known as the Universal Definition and Classification of Heart Failure to define this condition better and to improve patient outcomes. [3] Because of the high degree of variance in CHF symptoms, the condition is largely graded by patient mortality risk.
In total, there are 4 stages of congestive heart failure:
Whether you’re at stage A or D of CHF, it’s important to understand that all four stages are progressive: without proper management and lifestyle changes, even stages that don’t present with symptoms can worsen over time. This can result in a much lower quality of life, high healthcare costs, and even fatality.
With that said, it’s important to take any CHF diagnosis seriously. Knowing what makes each stage distinct can help you gain a clearer picture of your treatment options and allow you to feel motivated to be proactive about your health.
If you're diagnosed with Stage A congestive heart failure, you won’t experience any cardiac or pulmonary symptoms or structural abnormalities impacting the heart.
Instead, you may have other diagnosed health conditions or considerations that could put you at risk, including [6]:
Treating any associated conditions in cooperation with your healthcare provider can greatly improve outcomes for Stage A congestive heart failure.
For instance, if you’ve been diagnosed with diabetes, be sure to monitor your blood glucose levels and to take any medication you’ve been prescribed regularly. Adopting new lifestyle habits (these can be found below) may also significantly improve outcomes for conditions like hypertension and metabolic syndrome.
Pre-heart failure is also asymptomatic: it does not present with symptoms of heart failure. [8] However, it can be associated with structural damage or signs of added pressure to the heart. [6] You may also [8]:
If you have Stage B heart failure, you may notice that ordinary physical activity is becoming more difficult, or makes you feel tired or winded. [9] At this stage, your healthcare provider may strongly urge you to adopt certain habits that may reduce your chances of CHF's progression. These habits could include [12]:
Symptomatic heart failure is the stage that first presents with concrete CHF symptoms. At this level, your heart has sustained structural damage and may cause symptoms such as [13]:
Other symptoms of Stage C heart failure tend to vary depending on which part of the heart has been impacted.
For instance, if you have left-sided heart failure, you’ll be more prone to fluid buildup in the lungs, leading to a feeling of short or thin breath. [13] You may also notice [13]:
Right-sided heart failure is rarer, but it’s typically associated with fluid buildup throughout the body. [13] You may also experience symptoms like chest discomfort, increased urination, and appetite loss. [13]
Advanced heart failure (which you may see referred to as AdHF) is the most severe and is often fatal. At this stage (if not Stage C), your healthcare provider may urge you to consider long-term treatments to protect your mortality. These include [3]:
Prognosis for Stage D congestive heart failure is worrisome, as most people will require hospitalization and palliative care. [3] At this point, CHF is considered systemic, affecting multiple systems and organs of the body. Around 89% of Stage D CHF patients will lose their lives as a result of pump failure. [3]
Though congestive heart failure is widespread, several diagnosable related health conditions can heighten your risk of developing it. These include:
It’s currently estimated that around half of people diagnosed with heart failure are overweight or obese. [19] If you’re overweight, excess body fat makes it very hard for your heart to do its job. [19] You may also have or be at risk for conditions that contribute to CHF, including hypertension, high cholesterol, diabetes, and more.
Health experts stress that, with obesity-related CHF, losing weight is the keystone of effective treatment. Without it, your heart will continue to work under added stress, making other treatment modalities largely ineffective. [19]
In addition to being overweight, the following lifestyle factors can also put you at higher risk of CHF [1]:
If you’re over the age of 65, or have had a heart attack before, you may also be at risk of CHF. [20]
Any CHF diagnosis is a time to open up a conversation with your healthcare provider on short- and long-term solutions.
Can heart failure be reversed? It’s possible it can be reversed or halted if it is diagnosed early. While lifestyle changes are effective—and usually necessary—features of treatment, and interventions like medications (ACE inhibitors, beta-blockers) can also be life-saving. [9] Progressed CHF may require implant devices (e.g. ICDs (implantable cardioverter-defibrillators)) to better control or monitor your heart health. Severe CHF may require transplant surgery.
No matter which type of congestive heart failure you have, making intentional changes to your lifestyle can support you in achieving the best quality of life possible. The most effective means of managing CHF, especially early-stage CHF, include [9]:
Learning how to improve your resting heart rate may also help your overall heart health.
Whether or not you’ve recently been diagnosed with CHF, Everlywell provides the tools you need to take a preventative approach to your heart health. The Everlywell At-Home Heart Health Test measures your cholesterol, triglycerides, and other cardiovascular health biomarkers to help you better monitor your status.
With physician-reviewed results, you’ll receive the data you need to catch health hazards early—as well as access to a network of vetted telehealthcare professionals to counsel you on next steps in your journey.
Shop all Everlywell tests today to support your heart health and reach a new standard in at-home care.
A Guide to Resting Heart Rate by Age and Gender
Can Heart Failure Be Reversed?
Stroke vs. Heart Attack: Key Differences & Symptoms
References