Table 1.

Comparison of the HF staging defined by different international guidelines

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.