Every minute of every day, at least one person in the United States dies of heart disease. More than 616,000 Americans died of heart disease in 2007, according to the Centers for Disease Control and Prevention. For most patients, heart disease is a slowly progressive condition. Early-stage disease often proves manageable with lifestyle interventions, medication and possibly surgery. Increasing symptoms despite intensive medical efforts to manage the condition characterize end-stage heart disease.
ACCF/AHA Stage C
The American College of Cardiology Foundation and the American Heart Association classification system for heart failure divides the condition into four stages, denoted by the letters A through D. In the ACCF/AHA system, stage A represents early disease and stage D connotes end-stage heart failure.
Patients with stage C heart failure have disease-related symptoms, including shortness of breath, poor tolerance of physical activity and persistent fatigue. Treatment for patients with stage C heart failure involves several components. The 2009 ACCF/AHA guidelines for the treatment of heart failure state that lifestyle modifications for patients with stage C disease may include stopping smoking; eliminating alcohol intake and use of street drugs; losing weight if overweight or obese; restricting salt intake; eating a low-fat, healthy diet; and participating in a low-intensity, prescribed program of physical activity to maintain muscle strength.
Prescription medications help support heart function in patients with stage C disease. Treatment may reduce symptoms and improve the ability to tolerate physical activity. Medications commonly used for stage C heart failure include diuretics, angiotensin converting enzyme inhibitors, beta-blockers, angiotensin II receptor blockers, digitalis and nitrates.
ACCF/AHA Stage D
Patients with ACCF/AHA stage D heart failure have disease-related symptoms at rest despite intensive medical therapy. Patients with stage D heart disease, also known as refractory heart failure, are medically fragile and typically require frequent hospitalization and close outpatient monitoring.
Without extraordinary medical interventions, patients with stage D heart failure have a guarded prognosis. For patients with isolated heart disease, evaluation for heart transplantation may be appropriate. A ventricular assist device can prolong survival for some patients with stage D disease by compensating for the markedly reduced pumping capacity of the heart, explains the National Heart, Lung and Blood Institute. Ventricular assist devices are most commonly used in patients awaiting heart transplantation. Hospice care may be appropriate for patients who are not candidates for extraordinary treatments or choose not to pursue such measures.
NYHA Stage IV
The New York Heart Association classification of heart failure is another categorization scheme used to describe heart disease severity. The NYHA system consists of four stages, denoted I through IV, with stage IV representing end-stage disease, explains the Cleveland Clinic. NYHA stage IV heart failure is equivalent to ACCF/AHA stage D disease.
References
- Centers for Disease Control and Prevention: Leading Causes of Death
- "Circulation"; 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; Mariell Jessup, M.D., et al.; April 2009
- National Heart, Lung and Blood Institute: Ventricular Assist Device
- Cleveland Clinic: Heart Failure
- "Harrison's Principles of Internal Medicine, 16th Edition"; Dennis L. Kasper, M.D., et al., Editors; 2004
