End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed.

2nd University Cardiology Clinic Attiko Teaching Hospital Athens Greece

Bakulev Scientific Center for Cardiovascular Surgery Moscow Russia

Cardiology and Coronary Care Department Clinico Santiago de Compostela Spain

Cardiology Department Hospital Universitario de Santa Maria Lisbon Portugal

Cardiology Intensive Care Unit O Bogomolets National Medical University Kiev Ukraine

Clínica El Rosario Medellin Colombia

Clinical Department of Anaesthesiology and Intensive Care University Hospital of Split Croatia

Critical Cardiology Department Centro Cardiologico Monzino Milan Italy

Critical Care Orion Pharma Espoo Finland

Department of Cardiology Akademiska Hospital Uppsala Sweden

Department of Cardiology Cardiology Intensive Care Unit The 4th Military Hospital Wroclaw Poland

Department of Cardiology Cardiovascular Center Na Homolce Hospital Prague Czech Republic

Department of Cardiology Galilee Medical Center Nahariya Israel

Department of Cardiology Niguarda Ca'Granda Hospital Milan Italy

Department of Cardiology University of Debrecen Hungary

Department of Cardiovascular Respiratory Nephrology and Geriatric Science University of Rome Italy

Department of Cardiovascular Science University of Insubria Circolo Hospital and Macchi Foundation Varese Italy

Department of Intensive Care Klinikum Dortmund Germany

Department of Intensive Internal Medicine University Medical Center Ljubljana Slovenia

Department of Internal Medicine 1 University Hospital Krems Karl Landsteiner University of Health Sciences Austria

Department of Internal Medicine Kliniken Nordoberpfalz Weiden Germany; Teaching Hospital of the University of Regensburg Germany

División de Educación en Salud UMAE Hospital de Cardiología Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social Mexico

Fundación Valle del Lili Cali Colombia

Heart and Vascular Center Semmelweis University Budapest Hungary

Heart Failure Clinic and Echo Lab Gennimatas General Hospital of Athens Greece

Heart Failure Heart Transplant Department Centro Médico Zambrano Hellion Heart Failure Clinic Unidad Médica de Alta Especialidad Hospital de Cardiología No 34 IMSS Monterrey Nuevo León Mexico

Helsinki University Central Hospital Helsinki Finland

Hospital das Clínicas da Faculdade de Medicina University of São Paulo Brazil

IMIM Hospital del Mar Medical Research Institute Barcelona Spain

Institute of Anaesthesiology University Hospital Zurich Switzerland

S Francisco Xavier Hospital CHLO NOVA Medical School Faculdade de Ciências Médicas Universidade Nova de Lisboa Portugal

Scientific Research Institute of Physico Chemical Medicine of the Federal Medico Biological Agency of the Russian Federation Moscow Russia

University of Bergen Stavanger University Hospital Norway

References provided by Crossref.org

Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use