American College of Cardiology American Heart Association Classification

The newer ACC/AHA classification for CHF takes into account risk factors in addition to the presence of left ventricular dysfunction and symptoms (Hunt et al., 2001). This classification complements the New York Heart Classification (NYHC) and considers recent advances in pharmaco-logic and nonpharmacologic approaches to evaluate and treat the heart failure patient (Ahmed, 2003). The following four stages are proposed:

Stage A describes patients who are at risk of CHF but are asymptomatic and have no left ventricular dysfunction. More than 60 million people fall in this category and include those with CAD, hypertension, diabetes mellitus, and a family history of cardiomyopathy. Stage A is an additional classification that was not present in the prior NYHC.

Stage B describes patients with left ventricular dysfunction but no symptoms. This is equivalent to Class I of the NYHC. This includes about 10 million people in the United States.

Stage C describes patients with left ventricular dysfunction who are symptomatic with exertion. This is equivalent to the NYHC Class II and Class III. This includes about 5 million people in the United States.

Stage D describes patients with symptoms at rest. This is equivalent to Class IV of the NYHC. This includes about 200,000 people in the United States.

This classification reliably allows the physician to follow patients as their heart failure progresses from one stage to the next and offers a unique set of treatment appropriate to each stage.

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