Classes and Stages of Heart Failure

Quick Facts

  • There are four stages of heart failure.
  • If you have stage C or stage D, your health care professional will identify and monitor the class of your heart failure.

Even though someone has heart failure, they can still lead full, enjoyable lives. Heart failure is not the same for everyone.

Heart failure can progress. So, it has been broken down into four stages — A, B, C and D. When heart failure is in stage C or D, health care professionals also assign a classification. This classification measures a person’s overall heart function and how bad the symptoms are.

Stages of Heart Failure

The American Heart Association and the American College of Cardiology have identified the four stages of heart failure described below.

Stage A:
At risk for heart failure

People at risk for heart failure but do not yet have symptoms or structural or functional heart disease
Risk factors for people in this stage include:

Stage B:
Pre-heart failure

People without current or previous symptoms of heart failure but with:

  • Structural heart disease
  • Increased filling pressures in the heart
  • Other risk factors
Stage C:
Symptomatic heart failure People with current or previous symptoms of heart failure
Stage D:
Advanced heart failure People with heart failure symptoms that disrupt daily life functions or lead to being hospitalized

© 2022 by the American Heart Association, Inc., the American College of Cardiology Foundation, and the Heart Failure Society of America (Circulation.2022;145:e895-e1032)

Classes of Heart Failure

By classifying patients in stage C and stage D heart failure, health care professionals know better how to treat people in these stages of heart failure. People are classified based on how severe their symptoms are.

The most commonly used system is the New York Heart Association (NYHA) Functional Classification. It places patients in one of four classes based on their physical activity limitations.

If you have stage C or stage D heart failure, your health care professional will give you an NYHA Functional Classification as a baseline. Then, as you have treatment, you will be assigned another classification of your condition. This allows your care team to measure how well your treatment is working.

The table below describes the classes in the NYHA Functional Classification.

Class Patient Symptoms
I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or shortness of breath.
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, shortness of breath or chest pain.
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain.
IV Symptoms of heart failure at rest. Any physical activity causes further discomfort.

Adapted from Dolgin M, Association NYH, Fox AC, Gorlin R, Levin RI, New York Heart Association. Criteria Committee. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Lippincott Williams and Wilkins; March 1, 1994.
Original source: Criteria Committee, New York Heart Association, Inc. Diseases of the Heart and Blood Vessels. Nomenclature and Criteria for diagnosis, 6th edition Boston, Little, Brown and Co. 1964, p 114.
©1994 American Heart Association, Inc.

Disability Parking Placards

If heart failure makes it hard for you to walk far, you may qualify for a disability parking placard. Each state has its own agency that controls and gives:

  • Driver licenses
  • Vehicle registrations
  • Disability parking placards

This branch is often your state’s Department of Motor Vehicles.

Last Reviewed: May 21, 2025