Systolic congestive heart failure is a serious condition that occurs when the heart does not pump blood effectively. There are four stages of congestive heart failure.

Congestive heart failure may happen when the heart muscle is too weak or when another health issue prevents it from circulating blood efficiently. Over time, systolic congestive heart failure, or heart failure (HF), can lead to dysfunction of other organs due to inefficient pumping.

There are four stages of systolic heart failure: A, B, C, and D. A person’s chance of surviving decreases when the condition progresses to the next stage.

This article discusses how HF progresses over time and explains the outlook for people with this condition. It also examines the causes, symptoms, treatment options, and stages.

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People with stage A HF do not yet have issues with their heart’s pumping activity but have a high risk of developing HF due to related conditions, such as:


A person usually has no symptoms of HF at this stage but may experience symptoms of their chronic conditions.


People with this stage of HF have no issues with the structure of the heart or how their heart works. Treatment should focus on managing risk factors.

Structural heart disease develops at this stage, such as reduced heart pumping, which can lead to an enlarged left ventricle. It can also result from a previous heart attack.


Most people at stage B still do not show symptoms of HF.


A doctor may prescribe medication at this stage for the management and prevention of future issues. At this stage, it is common for a doctor to prescribe angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs) and beta-blockers.

People at this stage will show symptoms of HF linked to underlying structural heart disease, including fatigue or breathlessness. These symptoms usually occur due to problems with the squeezing function of the left ventricle or the pumping chamber of the heart.

Stage C HF also includes people who no longer show symptoms but are currently undergoing treatment for previous symptoms, such as those who spent time in the hospital with heart failure exacerbation.


Common symptoms include:


A doctor will prescribe medication at this stage to manage and prevent future issues. It is common for a doctor to prescribe:

A doctor may also consider implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT).

At stage D, people will have advanced structural heart disease and display significant symptoms, even when they are at rest.


Symptoms may include:


This stage is severe and may require advanced specialized treatment. This can include:

  • mechanical circulatory support
  • continuous inotropic infusion to make the heart squeeze harder
  • cardiac transplant
  • hospice care

The most common type of HF is left-sided HF. The left side of the heart must work harder to move the same volume of blood around the body. This may cause a fluid buildup in the lungs and make breathing difficult as it progresses.

These fluids give congestive heart failure its name.

There are two kinds of left-sided HF.

With systolic heart failure, the left ventricle cannot contract as usual, limiting the heart’s pumping ability. The stages of HF are commonly used for systolic HF but can also refer to other types.

With diastolic heart failure, the muscle in the left ventricle stiffens. If the muscle cannot relax, the pressure in the ventricle increases, causing symptoms.

Right-sided HF is less common. It occurs when the right ventricle cannot pump blood to the lungs. This can lead to blood backing up in the blood vessels, which may cause fluid retention in the lower legs and arms, abdomen, and other organs.

A person can have left-sided and right-sided HF at the same time. However, HF usually begins on the left side and can affect the right side if a person does not receive effective treatment.

Symptoms of HF range from mild to severe but may worsen over time without medical management.

Lifestyle strategies can reduce the risk of developing HF and can also slow its progress.

People can take the following steps to help prevent or slow the progression of HF:

  • Maintaining a moderate body weight: Excess body weight can place strain on the heart and increase the risk of further damage.
  • Exercising regularly: The American Heart Association (AHA) recommends getting 150 minutes of moderate-intensity exercise every week. Individuals with heart failure should talk with their doctors about getting an individualized exercise “prescription.”
  • Managing stress: Meditation, therapy, and relaxation techniques can help a person manage stress, which can have adverse effects on the heart.
  • Eating a heart-healthy diet: Daily food intake should be low in trans fats, rich in whole grains, and low in sodium and cholesterol. Experts often recommend that people with severe heart failure limit their sodium intake to 2,000 milligrams (mg) daily. However, individuals should check with their doctor to determine their target sodium and fluid intake.
  • Monitoring blood pressure regularly: A doctor can do this at regular check-ups. However, doctors also recommend people use home blood pressure monitors.
  • Getting vaccinations: A person should stay on top of vaccinations for influenza and pneumonia.
  • Addressing risk factors: People can address and manage any applicable risk factors, such as high blood pressure and diabetes, and stop smoking, drinking alcohol, and taking drugs, if necessary.

People who already have HF can take the following necessary steps to help prevent the condition from progressing:

  • avoiding alcohol
  • limiting caffeine and other stimulants
  • getting adequate rest
  • tracking changes in their symptoms and exercise capacity
  • getting weighed each day
  • checking blood pressure and heart rate at home

Without treatment, HF can be fatal. Even with adequate treatment, HF may worsen over time, triggering dysfunction of other organs throughout the body.

HF is more likely to occur in people with other conditions or lifestyle factors that weaken the heart.

Risk factors for HF include:

A doctor or cardiologist will perform a physical exam. This involves listening to the heart, checking for fluid retention, and looking at the veins in the neck to see whether extra fluid is present in the heart. They may order other diagnostic tests, including:

  • Electrocardiogram: This records the heart’s electrical rhythm.
  • Echocardiogram: This is an ultrasound test that can help a doctor determine whether a person has a leaky heart valve or a heart muscle that is not squeezing or relaxing properly.
  • Stress tests: These tests show how the heart performs under different levels of cardiac stress, such as during exercise. Sometimes, stress tests involve medications that stimulate the heart to beat faster and harder or cause the blood vessels to relax.
  • Blood tests: A doctor may request these to check for infections, assess kidney function, and assess levels of brain natriuretic peptide (BNP). BNP is a “stretch” hormone that indicates stretching or increased pressure that occurs with HF.
  • MRI: This can provide high resolution images of the heart and can assess for structural changes and scarring.
  • Cardiac catheterization: This can help a doctor identify blockages in the arteries, one of the most common causes of HF. A doctor may check blood flow and pressure levels in the ventricles at the same time.

Different medications can help with the symptoms and outlook of HF. These include:

  • Blood thinners: These reduce the risk of blood clots, which might break loose and travel to the body, heart, lungs, or brain. Blood thinners carry risks such as increased bleeding.
  • ARNIs: These help reduce the risk of mortality and decrease congestion in the heart.
  • MRAs: They can lower blood pressure, reduce congestion, and block the effects of hormones from the adrenal glands that can damage the heart.
  • ACE inhibitors: These relax the blood vessels and help reduce the effects of heart failure.
  • ARBs: These work to reduce tension in the blood vessels.
  • Anti-platelet drugs: Doctors prescribe these to stop blood clots. They prevent platelets in the blood from sticking together.
  • Beta-blockers: These drugs lower the heart rate, the force of the heartbeat, and blood pressure, helping to “rest” the heart.
  • Sinoatrial node modulators: These can help further reduce the heart rate in people already taking beta-blockers.
  • SGLT2 inhibitors: These can help reduce the risk of cardiovascular death and heart failure hospitalization.
  • Statins: People take statins to help reduce low-density lipoprotein, or “bad” cholesterol, and increase high-density lipoprotein, or “good” cholesterol.
  • Diuretics: These help the body excrete excess fluid in the urine and remove it from the heart and lungs. They also reduce swelling and prevent shortness of breath.
  • Vasodilators: These reduce the amount of oxygen that the heart needs to dilate. Vasodilators can also help ease chest pain.

Learn more about heart failure medications.

People with advanced HF might need more intensive treatment. Medical procedures that may help include:

Implantable devices

A surgeon might implant a medical device, such as:

  • An implantable defibrillator: These can prevent arrhythmias or irregular heartbeats.
  • A pacemaker: These address electrical problems in the heart to help the ventricles contract more regularly.
  • CRT: A CRT device works as a pacemaker but also delivers electrical impulses to help synchronize the left and right ventricles.
  • A left ventricular assist device (LVAD): This supports the heart’s pumping ability when it cannot pump efficiently on its own. People once used LVADs on a short-term basis but can now use them as part of long-term treatment.

Other procedures

A doctor may recommend other procedures for treating HF, including:

  • Percutaneous coronary intervention to open a blocked artery: The doctor may place a stent to help keep the vessel open.
  • Coronary artery bypass surgery: This reroutes some of the blood vessels so that blood can travel to supply oxygen to the heart while avoiding diseased or blocked blood vessels.
  • Valve replacement or repair surgery: A doctor can replace or repair an inefficient or diseased valve with a mechanical valve or one developed from living tissue.
  • Heart transplant: This may be the only remaining option if other treatments are not effective.

Not everyone with HF is an appropriate candidate for a transplant, and people often have to wait a long time before having one.

Heart surgery can be dangerous and invasive but is sometimes necessary, in combination with medications, to help treat HF in the best possible way.

Here are some common questions about congestive heart failure:

What are the 4 stages of congestive heart failure?

The four stages of heart failure are A, B, C, and D.

What is the life expectancy of someone with congestive heart failure?

Research from 2019 estimates that more than half of all people with congestive heart failure will survive for 5 years after diagnosis. About 35% will survive for 10 years.

Older individuals may have a higher risk of dying from heart failure.

How quickly does heart failure progress?

This will vary from person to person. It is often difficult to predict how quickly the condition will progress. For some, it may be stable for several years before worsening. And for others, heart failure progresses rapidly.

Careful monitoring by a doctor or cardiologist can help a person manage disease progression.

Can you recover from congestive heart failure?

There is no cure for CHF. Still, certain lifestyle changes, such as following a heart-healthy diet and getting regular exercise, may help slow progression and improve a person’s quality of life.

Congestive heart failure has four stages: A, B, C, and D. When the condition progresses to the next stage, a person’s chance of surviving decreases.

Each stage may require a different treatment approach. Lifestyle changes, medication, and surgery are typical methods of treatment.

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