End-stage heart failure: quantity or quality of life?

Several clinical trials testing the safety and efficacy of different positive inotropic agents in patients suffering form end-stage heart failure have confirmed that these drugs increase mortality. We. nevertheless, use these agents regularly because of the presumption that they improve quality of life. However, this presumption, sound a priori, is not firmly anchored. When we prescribe these drugs, do we inform our patients? Do the patients ultimately decide whether to be treated with inotropic agents? What is the role of palliative care in the end-stage heart failure patient? We review the literature and reflect on these issues, long completely ignored, though beginning to elicit specific articles.