Heart failure with reduced ejection fraction (HFrEF)

During or after testing for systolic heart failure, your healthcare professional may tell you the stage of disease. Staging helps determine the most appropriate treatment. There are two main ways to determine the stage of heart failure:

New York Heart Association (NYHA) classification

This system groups heart failure into four categories by number. You may see Roman numerals used for these category names.

• Class 1 heart failure. There are no heart failure symptoms during daily activities or mild exercise.
• Class 2 heart failure. Everyday activities can be done without difficulty. But exertion causes shortness of breath or fatigue.
• Class 3 heart failure. It's difficult to complete everyday activities.
• Class 4 heart failure. Shortness of breath occurs even at rest. This category includes the most severe heart failure.

American College of Cardiology/American Heart Association classification

This stage-based classification system uses letters A to D. It includes a category for people who are at risk of developing heart failure.

• Stage A. There are several risk factors for heart failure but no signs or symptoms.
• Stage B. There is heart disease but no signs or symptoms of heart failure.
• Stage C. There is heart disease and signs or symptoms of heart failure.
• Stage D. There is advanced heart failure that needs specialized treatments.

Healthcare professionals often use the classification systems together to help decide the most appropriate treatment options. Your health professional can help you interpret your stage.