(Updated June 3, 2025)
Let’s start with some quick stats about congestive heart failure:
- Congestive heart failure currently affects approximately 6.7 million adults in the United States over the age of 20. (CDC)
- The prevalence of congestive heart failure is expected to rise to 8.7 million by 2030 and to 11.4 million by 2050. (JCF)
- Congestive heart failure was the direct or indirect cause of death for nearly 14% of U.S. citizens in 2022. (CDC)
- 36% of all cardiovascular disease-related deaths can be attributed to congestive heart failure. (HFSA)
- It is estimated that there are 960,000 new cases of congestive heart failure each year. (HFSA)
Congestive heart failure is a serious condition for individual patients, and it is a continuously worsening issue across the nation. If you’re at risk, knowing what congestive heart failure is, its four stages, and how to prevent it can give you the knowledge and tools you need to protect your heart and avoid developing this life-threatening condition.
Before we can evaluate the four stages of congestive heart failure, it’s important to understand what it is, what can cause it, and what the signs of congestive heart failure are.
What Is Congestive Heart Failure?
Congestive heart failure is a condition in which the heart muscle weakens to the point where it no longer functions efficiently. While the body needs the heart to supply enough blood, oxygen, and other nutrients on a strong and consistent basis, congestive heart failure prevents the heart from keeping up with the required blood distribution, leading to uncomfortable and dangerous complications.
Systolic Heart Failure and Diastolic Heart Failure
Patients can develop one of three types of congestive heart failure:
- Systolic Heart Failure: A condition in which the heart is unable to pump blood.
- Diastolic Heart Failure: A condition in which the heart cannot fill back up with blood properly.
- Combined Systolic and Diastolic Heart Failure: A condition in which the heart cannot pump or receive blood adequately.
What Are the Risk Factors for Congestive Heart Failure?
There are a number of preexisting conditions and other risk factors that can increase a patient’s likelihood of developing congestive heart failure. These conditions or risk factors include those related to personal factors and family history, preexisting issues, and lifestyle choices:
Personal Factors and Family History
- Reaching and exceeding 65 years of age
- Being of African descent
- Family history of cardiovascular disease
Preexisting Issues
- Chronic high blood pressure, or hypertension
- Coronary artery disease (CAD)
- Valvular heart disease (VHD)
- Cardiomyopathy
- Congenital heart disease
- Personal history of heart attacks
- Lung disease
- Diabetes
- Obesity
- Sleep apnea
Lifestyle Choices
- Smoking
- Excessive alcohol consumption
- Drug use, especially cocaine and other illicit drugs
- Physical inactivity
- Low-nutrient diet that is high in saturated and trans fats, cholesterol, and sodium
Keep in mind that having one or several of these conditions or risk factors does not mean it’s a guarantee that you will develop congestive heart failure. Consulting with your cardiologist and making a proactive plan to improve your heart health can allow you to protect your heart and avoid developing congestive heart failure in the future.
What Are the Symptoms of Congestive Heart Failure?
For many patients, the signs and symptoms of congestive heart failure appear so subtly at first that they are mistaken for the typical signs of aging. However, as the condition progresses, symptoms can become more and more noticeable and troubling.
Congestive heart failure symptoms in the early stages can include:
- Fluid retention in the abdomen or lower extremities
- Congestion in the lungs and other body parts
Congestive heart failure symptoms in the later stages can include:
- Shortness of breath during simple activities
- Breathing difficulties while reclining or lying down
- Shortness of breath in the middle of the night
- Excessive urges to urinate, especially at night
- Excessive fatigue
- Excessive coughing
- Light pink or bloody mucus
- Swelling in the feet, ankles, or legs
- Swelling in abdomen
- Nausea
- Lack of concentration
- Cold sensations in the arms and legs
What Are the Four Stages of Congestive Heart Failure?
Because congestive heart failure worsens over time, cardiologists divide the condition into four distinct stages. This allows doctors to provide the best treatments and therapies based on how much their patients’ condition has progressed.
The four stages of heart failure include Stage A (stage 1), Stage B (stage 2), Stage C (stage 3), and Stage D (stage 4):
Stage A
Stage A congestive heart failure (sometimes referred to as stage 1) is actually the pre-stage of the condition. Doctors consider patients to be in Stage A if they are at a high risk of developing congestive heart failure. Patients in Stage A do not have any structural damage to the heart muscles yet, but other health conditions or risk factors are putting them at high risk of developing damage over time.
High-risk factors can include any combination of the following:
- Hypertension
- Diabetes
- Coronary artery disease
- Cardiomyopathy or a family history of cardiomyopathy
- Metabolic syndrome
- Rheumatic fever
- History of excessive alcohol consumption
- History of drug use
Stage B
Stage B congestive heart failure (sometimes referred to as stage 2) is also a stage of pre-heart failure in which the left ventricle begins to weaken or malfunction. However, the patient still does not experience any noticeable symptoms of heart failure. In stage B, the heart muscle develops initial damage, which can worsen as the condition progresses.
Stage B can be diagnosed via echocardiogram, or an ultrasound of the heart.
Stage C
Stage C congestive heart failure (sometimes referred to as stage 3) is the stage in which patients begin to notice symptoms associated with congestive heart failure. As their heart muscles have weakened and malfunctioned more, their body begins showing signs of the condition.
Noticeable symptoms in stage 3 of congestive heart failure include:
- Excessive coughing
- Shortness of breath
- Fatigue
- Nausea
- Swelling in the abdomen, legs, feet, and ankles
- Irregular or rapid heartbeat
Stage D
Stage D congestive heart failure (sometimes referred to as stage 4) is also considered end-stage heart failure, as it is the most advanced stage a patient can reach. Neither the heart nor the symptoms can improve with the same treatment or therapies that are often effective for the previous stages. Since it is the final stage of heart failure, patients in Stage D can expect frequent hospitalizations for symptoms as well as a shorter life expectancy—life expectancy is much lower than it is in stages A, B, and C.
While there is no cure or ability to improve heart health in stage D of congestive heart failure, there are advanced treatments and management plans to help manage symptoms and prolong the patient’s life. These include:
- Medications
- Device therapy
- Infusions or intravenous inotropic drugs
- Heart transplant or other surgical options
Treatment for Congestive Heart Failure
When it comes to treating congestive heart failure, the best method is to detect it early and create a comprehensive treatment and management plan with a trusted cardiologist. In many cases, patients in stages A and B can slow progression significantly through effective medication, which can include:
- ACE-inhibitors
- Beta-blockers
- Blood pressure medications
- Diuretics
- SGLT2 inhibitors
And several others.
Your doctor will likely also recommend lifestyle changes, which can include:
- Quitting smoking
- Reducing alcohol consumption
- Adopting a heart-healthy diet (such as the DASH or Mediterranean diet)
- Getting regular exercise
Some patients may benefit from surgical procedures, including:
- Defibrillator implantation
- Cardiac resynchronization therapy
- Left ventricular assist device implantation
- Heart transplant
How Long Can I Live With Congestive Heart Failure?
Receiving the diagnosis of congestive heart failure can be scary, and it can feel as if you don’t have much time left. However, life expectancy with this condition varies widely. And with the right treatment and management, as well as a strict adherence to your cardiologist’s orders, you can improve your outcomes and prolong your life, even with congestive heart failure.
According to studies:
- Approximately 50% of people diagnosed with CHF survive five years or more after diagnosis.
- About 30% survive ten years or longer.
There are many factors involved in life expectancy with congestive heart failure. Talk to your cardiologist about your condition and what you can do to improve your health and extend your years.
The cardiologists at Middle Georgia Heart understand the fear of living with congestive heart failure. If you’re worried about what stage you might be in, schedule a consultation with our team today: 478-207-5224
Our heart doctors have years of experience helping patients treat and manage their congestive heart failure, regardless of what stage they are in. Through effective programs and treatment plans, we can help you manage your congestive heart failure as effectively as possible.
Schedule a consultation with us today: 478-207-5224
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