The goal of therapy in patients with severe symptomatic heart failure is improvement in symptoms, stabilization or improvement in functional abilities, and improved comfort for the remaining duration of life. Prolongation of survival without these benefits appears less desirable. There is poor correlation among hemodynamic features (including ejection fraction), exercise capacity, and quality of life attributes. Patients value as an outcome of therapy quality of life attributes: comfort, sense of well-being, and physical and other functional capabilities. By contrast, patients with asymptomatic ventricular dysfunction cannot anticipate any short-term benefit of therapy, whose goal is solely improvement in long-term survival. Interference by therapy with any aspect of life quality is likely to adversely affect compliance and thereby limit long-term outcome advantages.