While Symptoms Classes I-IV describe how you feel day to day, the Stages of Heart Failure describe what’s happening structurally in your heart and how dilated cardiomyopathy (DCM) may be progressing.
Progression
Heart failure can change over time, but many people remain in the same stage for years with the right care and regular follow-up.
Treatment
Treatment is tailored to your stage, starting with lowering risk factors, then supporting the heart and managing symptoms with medication. Appropriate medications can improve heart function and help people live longer with DCM. If needed, more advanced treatment options are available in later stages.
Understanding your heart failure stage helps you and your care team choose the most effective strategies to keep your heart as healthy as possible.
Stage A: At Risk
Your heart structure and function are still normal, but you are at risk of developing heart failure in the future.
Who this includes (but is not limited to)
People with a family history of cardiomyopathy, high blood pressure, diabetes, coronary artery disease, metabolic syndrome, or a history of heart-damaging drugs (like certain chemotherapies).
The goal
Prevention
The treatment
Manage the “why.” Control blood pressure and cholesterol, quit smoking, and exercise regularly. Medications like ACE inhibitors or beta-blockers may be used to reduce future risk.
Stage B: Pre-Heart Failure
(Structural Changes with No Symptoms)
Your heart has structural changes, such as enlarged chambers, reduced pumping function, or damage from a heart attack or genetic abnormality, but you do not yet feel symptoms.
Who this includes
People whose hearts show structural changes on tests (like an enlarged chamber, reduced pumping ability, or valve issues), without symptoms.
The goal
Stop or slow further changes to the heart muscle.
The treatment
All Stage A treatments, plus specific medications (ACE inhibitors, ARBs, beta blockers) to help the heart remodel itself. Some patients may be candidates for an ICD (defibrillator) at this stage.
Stage C: Heart Failure (Structural Changes with Symptoms)
Structural changes have occurred, and you are currently experiencing (or have experienced) symptoms of heart failure.
Who this includes
Stage C is the most common stage at diagnosis, and you are likely experiencing fatigue, shortness of breath, and decreased exercise tolerance.
The goal
Manage symptoms and improve quality of life.
The treatment
Stage A and B treatments, plus additional medications (like diuretics for swelling) and possibly specialized devices such as biventricular pacemakers. Some patients may also need surgeries like coronary artery bypass or valve procedures.
Stage D: Advanced Heart Failure
Significant structural changes and persistent symptoms despite optimal medications and rest.
Who this includes
You have severe, ongoing symptoms that may require frequent hospital visits.
The goal
Advanced intervention or comfort.
The treatment
All previous treatments, plus intravenous heart medications, mechanical pumps (LVADs), or a heart transplant. For some, the focus may shift to palliative or hospice care to ensure comfort and quality of life.
Key Takeaway: The “One-Way” Ladder
Heart failure stages are usually a one-way progression, like climbing a ladder. You generally don’t go back a stage (for example, from Stage C to Stage B).
The good news: With the right treatment and lifestyle habits, many people stay in Stage B or C for years, maintaining stability and a good quality of life.
Download Global Heart Hub’s Guide to Heart Failure