Inclusion Criteria:  Evidence of HFrEF according to ESC HF guidelines, preferably LVEF ≤ 35% Evidence of in-hospital worsening heart failure requiring escalation of inotropic therapy according to the treating heart failure cardiologist based on at least 3 / 4 predefined hemodynamic and clinical criteria No previous episodes of inotropic treatment during current admission or within the last month Age: 18 - 80 years  Exclusion Criteria:  Contraindications for Impella CP Severe concomitant RV failure Grade IV mitral regurgitation eligible for surgical treatment Contraindications for inotropic usage Dialysis for end-stage renal failure Acute coronary syndrome History of CVA or TIA within previous 90 days History of acute myocardial infarction within previous 30 days History of bleeding diathesis or known coagulopathy (including heparin-induced thrombo-cytopenia), any recent GU or GI bleed, or will refuse blood transfusions Inflammatory Active systemic infections Acute myocarditis Active on transplant waiting list