Table 1.
Table summary showing different HF classifications and staging systems. In the first column, LVEF-based classification by ESC, which differentiates HF into three types, according to ejection fraction: HFpEF, HFmrEF and HFrEF; in the second column, NHYA class, which stages HF according to symptoms severity; in the third column, the evolution stages proposed by the new Universal Definition and Classification of Heart Failure, which considers more parameters, such as risk factors, circulating biomarkers, morphological, functional parameters and response to therapy; in the fourth column, the HF phenotypes classification, which considers several parameters, such as blood pressure and heart rate, in order to obtain a pragmatic treatment strategy.
| LVEF | NYHA Class | Evolution Stages | Phenotypes |
|---|---|---|---|
|
(1) LVEF ≥ 50% (HFpEF) (2) LVEF 41–49% (HFmrEF) (3) LVEF ≤ 40% (HFrEF) |
(I) No limitations in normal physical activity (II) Mild symptoms in normal activities with slight limitation in physical activity (III) Marked symptoms and limitations during daily activities, without symptoms at rest (IV) Severe symptoms and limitations, even at rest |
STAGE A Patients likely to develop HF, due to risk factors presence, in the absence of cardiac abnormalities and/or signs and symptoms STAGE B (pre-HF condition) Structural and/or functional and/or elevated natriuretic peptides or troponins, in the absence of signs and symptoms STAGE C Current or prior symptoms and/or signs of HF, determined by structural and/or functional cardiac abnormalities STAGE D (Advanced HF) Persistent and refractory symptoms and signs, despite OMT, requiring advanced therapeutic approaches |
(1) Low BP and high HR (2) Low BP and low HR (3) Normal BP and low HR (4) Normal BP and high HR (5) AF and normal BP (6) AF and low BP (7) CKD (8) Pre discharge patient (9) Hypertensive profile despite OMT |
LVEF: left ventricular ejection fraction; HF: heart failure; HFpEF: heart failure with preserved ejection fraction; HFmrEF: heart failure with mildly reduced ejection fraction, HFrEF: heart failure with reduced ejection fraction; NYHA: New York Heart Association; HF: heart failure; OMT: optimised medical therapy; BP: blood pressure; HR: heart rate; AF: atrial fibrillation, CKD: chronic kidney disease.