American College of Cardiology (ACC) Stages

A committee of members from the American College of Cardiology and the American Heart Association collaborated on a schema for classifying stages in the progression of heart failure.* Unlike the NYHA classes, this schema acknowledges established risk factors for the disease, and its asymptomatic as well as symptomatic stages. Each stage is given alongside a description of the types of patients it includes:

  • Stage A Patients at high risk of developing heart failure because of the presence of conditions that are strongly associated with the development of heart failure. Such patients have no identified structural or functional abnormalities of the pericardium, myocardium or cardiac valves and have never shown signs or symptoms of heart failure.
  • Stage B Patients who have developed structural heart disease that is strongly associated with the development of heart failure but who have never shown signs or symptoms of heart failure.
  • Stage C Patients who have current or prior symptoms of heart failure associated with underlying structural heart disease.
  • Stage D Patients with advanced structural heart disease and marked symptoms of heart failure at rest despite maximal medical therapy and who require specialized interventions.

*”ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure).” Hunt S.A., Baker D.W., Chin M.H., Cinquegrani M.P., Feldman A.M., Francis G.S., Ganiats T.G., Goldstein S., Gregoratos G., Jessup M.L., Noble R.J., Packer M., Silver M.A., Stevenson L.W. The Journal of the American College of Cardiology, 2001 (38: 2101-13).