- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Heart Failure Stages and Impact of Delayed Diagnosis
Panelists discuss how heart failure classification involves HFrEF vs HFpEF distinctions and staging systems (A through D), with the greatest prevention opportunities existing in early stages A and B, where patients have risk factors or subclinical dysfunction but haven’t yet developed overt clinical symptoms.
Heart failure classification systems provide crucial frameworks for clinical decision-making and risk stratification. The distinction between heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) remains fundamental, though HFpEF diagnosis presents greater complexity and is often missed when relying solely on echocardiographic assessment of diastolic dysfunction. Clinicians must maintain high clinical suspicion and work to exclude rather than confirm heart failure in patients with suggestive symptoms but normal ejection fraction.
The staging system (A through D) highlights critical opportunities for early intervention and prevention. Stage A includes patients with risk factors like obesity, hypertension, and diabetes but no structural heart disease. Stage B involves structural abnormalities without overt symptoms. Most clinical encounters occur at stages C and D, when patients have developed symptomatic heart failure or require advanced therapies. However, the greatest prevention opportunities exist in stages A and B, where early screening and risk factor modification can prevent or delay disease progression.
Early identification and intervention become increasingly cost-effective as the disease progresses and becomes more expensive and burdensome to treat. Upstream interventions targeting risk factors using many of the same medications effective for established heart failure (mineralocorticoid receptor antagonists for resistant hypertension, SGLT2 inhibitors for diabetes) can provide dual benefits. This approach represents a shift from reactive treatment of advanced disease toward proactive prevention and early intervention, potentially reducing the overall burden of heart failure while improving patient outcomes.
