Nevertheless, objective risk markers and scores, if deployed as part of a comprehensive assessment by an HF team, are useful for prognostication and prioritization [17]. Clinical history such as recurrent HF hospitalizations and the physician’s gestalt from the patient encounter are critical. Moreover, numerous plasma biomarkers of neurohormonal activation, cardiomyocyte injury or stress, inflammation, fibrosis and multifactorial markers are independent markers of outcome in patients with advanced HF [18]. The cardiopulmonary exercise test provides a set of integrated parameters that represent not only cardiac but also peripheral function. This finding may be particularly helpful in selecting patients who are not inotrope-dependent for LT-MCS therapy, given the fact that impaired exercise tolerance was an inclusion criterion in most LT-MCS studies.