Classification
Based on the left ventricular ejection fraction (LVEF) level measured by echocardiography during the patient’s initial assessment, heart failure can be classified into three basic types:
- [[Heart Failure with Reduced Ejection Fraction HFrEF]]
- [[Heart Failure with Mildly Reduced Ejection Fraction HFmrEF]]
- [[Heart Failure with Preserved Ejection Fraction HFpEF]]
- [[Heart Failure with Normal Ejection Fraction HFnEF]]
- [[Heart Failure with Supranormal Ejection Fraction HFsnEF]]
Additionally, there are several special types:
- [[Heart Failure with Improved Ejection Fraction HFimpEF]]
- [[Heart Failure with Recovered Ejection Fraction HFrecEF]]
- [[Heart Failure with Declined Ejection Fraction HFdecEF]]
- [[Heart Failure with Improved Preserved Ejection Fraction HFpimpEF]]
Staging
Based on the development process of heart failure, it can be divided into 4 stages:
| Stage | Definition and Criteria |
|---|---|
| Stage A (At risk for heart failure) | Presence of risk factors for heart failure but no current or prior symptoms and/or signs of heart failure; no structural and/or functional cardiac abnormalities; no biomarker abnormalities indicating cardiac strain or injury. For example, patients with hypertension, diabetes, atherosclerotic disease, metabolic syndrome and obesity, use of cardiotoxic drugs, carrying cardiomyopathy-related genetic variants or having a positive family history. |
| Stage B (Pre-heart failure) | No current or prior symptoms or signs of heart failure, but one of the following abnormalities: (1) Structural and/or functional cardiac abnormalities: including reduced left or right ventricular systolic function (reduced ejection fraction or reduced strain) or diastolic dysfunction, ventricular hypertrophy, chamber enlargement, wall motion abnormalities, and valvular heart disease; (2) Evidence of increased intracardiac pressure: indicated by invasive hemodynamic measurement or noninvasive imaging (such as Doppler echocardiography) showing elevated intracardiac filling pressure; (3) Elevation of natriuretic peptides or cardiac troponin levels in the presence of risk factors, with exclusion of other diagnoses causing elevation of these biomarkers such as acute coronary syndrome, chronic kidney disease, pulmonary embolism, or myocarditis/pericarditis. |
| Stage C (Symptomatic heart failure) | Presence of structural and/or functional cardiac abnormality, with current or prior symptoms and/or signs of heart failure. |
| Stage D (Advanced heart failure) | Persistent severe heart failure symptoms affecting daily life despite optimized therapy, with repeated hospitalizations for heart failure. |