From: Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management
Proposed New Staging of HF according to the universal definition [8] | Updates guidelines of the ACCF/AHA in 2009 [91] | NYHA functional classification [92] | |||
---|---|---|---|---|---|
At risk (Stage A) | At risk for HF, but without current or prior symptoms/signs of HF and without structural cardiac changes or elevated biomarkers | A | At high risk for HF but without structural heart disease or symptoms of HF | None | – |
Pre-HF (Stage B) | Without current or prior symptoms/signs of HF with evidence of one of the following: ¬ Structural Heart Disease ¬ Abnormal cardiac function ¬ Elevated natriuretic peptide levels or troponin levels | B | Structural heart disease but without signs or symptoms of HF | I | No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF. |
HF (Stage C) | Current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality | C | Structural heart disease with prior or current symptoms of HF | ||
 |  |  |  | II | Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF. |
 |  |  |  | III | Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF. |
Advanced HF (Stage D) | Severe symptoms and/ or signs of HF at rest, recurrent hospitalizations despite GDMT, refractory or intolerant to GDMT, requiring advanced therapies | D | Refractory HF requiring specialized interventions | IV | Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest. |