Inclusion Criteria

Patients with a confirmed diagnosis in accordance with the criteria proposed by the
European Society of Cardiology and with NYHA III-IV symptoms. And at least one of
following criteria;

1. At least one episode of worsening heart failure that resolved with injection /
infusion of diuretics or the addition of other heart failure treatment in the last 6
months and regarded optimally treated according to the responsible physician.

2. Need for infusions-treatment.

3. Chronic poor quality of life (VAS < 50)

4. Signs of cardiac cachexia (involuntary non-oedematous weight loss ≥ 6% of total body
weight within the last 6-12 months)

5. less than one year life expectancy.

Exclusion Criteria:

Ineligible are patients:

1. who do not want to participate in the study;

2. with severe communication problems;

3. with severe dementia;

4. with other serious disease in which heart failure is of secondary importance;

5. with other life-threatening illness as the primary diagnosis with expected short
survival;

6. when the Primary Care Center which is responsible for patient care is geographically
located from more than 30 km radius outside the hospital; and

7. participating in another clinical trial. -