Recommended Treatment By Stage of Heart Failure

The treatment for heart failure will depend on how much your symptoms affect your level of physical activity. Heart failure is identified by stages ranging from Stage A–no symptoms and no limitations on physical activity, to Stage D–symptoms are present even at rest and physical activity causes discomfort.


Stage A

(no limitation of physical activity, no symptoms)

ACE-inhibitors, beta-blockers, blood pressure medication, healthier lifestyle habits: reduce smoking and alcohol, eat right, and exercise.

Stage B

(slight limitation of physical activity, no symptoms)

All of the above plus diuretics, restricting fluids and salt, a biventricular CRT device.

Stage C

(noticeable limitation of physical activity, displays symptoms)

All of the above plus discussion of heart transplant, surgery, clinical trials, or hospice/palliative care.

Stage D

(physical activity with discomfort, displays symptoms even at rest)

End-stage disease.


  • ACE-inhibitors – An Angiotensin Converting Enzyme (ACE) inhibitor helps to dilate blood vessels to increase the amount of blood your heart can pump. It also works to stop the production of angiotensin II, which can build up in your vessels, block blood flow, and increase blood pressure.
  • Beta-blockers – Beta-blockers decrease the heart’s need for blood and oxygen by slowing the heart down. They also help the heart beat in a regular rhythm.
  • Diuretics – Diuretics can be prescribed to reduce swelling and fluid build up.


CRT pacemaker (CRT-P) – There are several types of pacemakers: single-, dual-, and triple-chamber devices. The triple-chamber pacemaker, also called a biventricular pacemaker, is used for cardiac resynchronization therapy (CRT). It has three leads: one in the right atrium, one in the right ventricle, and one in the left ventricle. The implantation of a CRT-P system is the same as for a pacemaker or defibrillator (ICD).

CRT defibrillator (CRT-D) – Most congestive heart failure patients have fast heart rhythms that put them at risk of dying from sudden cardiac death. CRT systems with an integrated defibrillator (CRT-D) synchronize the heartbeat and can also deliver electrical shocks to prevent life-threatening ventricular fibrillation.

MR conditional

Patients with devices have historically been considered ineligible for Magnetic Resonance Imaging (MRI). Beginning in 2011, the US Food and Drug Administration (FDA) has approved pacemaker and ICD technology that can be used safely during MRI. Today there are CRT devices available that are MR conditional.

This new technology allows CRT device and ICD patients to safely have an MRI exam if they need one in the future.

Automated Heart Rate Adjustment Sensors

Your doctor can program your CRT device to automatically increase your heart rate, based on what your body needs for various activities. The CRT device will make these rate adjustments, using one of the following sensors:

Motion Sensor (Accelerometer) – This sensor detects changes in motion (similar to smart phones rotating the image) and increases heart rate when an activity results in physical movement.

Biological Demand Sensor (Closed Loop Stimulation) – CLS is a unique sensor that reacts to physiologic demand, whether it is caused by acute mental stress or physical movement. This sensor is very successful at mimicking a healthy heart. It increases patients’ ability to perform low-energy consuming daily activities compared to an accelerometer.



The implantation of a CRT-P or CRT-D system is the same as for a pacemaker or defibrillator (ICD).

  1. The CRT device is inserted through a small incision on the left side of the body. The physician pushes three thin, insulated cables (leads) from the collarbone (clavicle) to the heart through a punctured vein. The leads are positioned in the heart using an X-ray screen. The physician pushes the leads through a vein and into the right atrium and the right chamber (ventricle). Another lead is inserted into the coronary vein to stimulate the left chamber.
  2. When the leads are correctly placed, the physician connects them to the CRT device, tests them and adjusts the settings.
  3. Then the physician puts the implanted device in a pocket in the pectoral muscle below the collarbone and closes it with a few stitches.


Living With

icon_aftercareAfter implant surgery, your doctor will give you instructions on activities to avoid and how to keep your incision clean and dry. You will also learn how implant sensors and monitoring will transmit information on battery life, lead function, and medical data on your condition.


icon_questionsEveryone has questions. We’ve got answers to the ones CRT device patients ask most.

This list of questions and answers can help you prepare for your next doctor’s consultation and possibly ease unnecessary fears.

Choosing Your CRT Device

Not all CRT devices are alike. Get our educational guide, Choosing Your CRT Device, and learn what functions are key to choosing the best device for your lifestyle.



Get our educational eguide, Understanding Abnormal Heart Rhythms, and learn about the basic heart functions and types of arrhythmia.