Inclusion Criteria:  NYHA/Ross class III or IV Severe impairment of ventricular function (EF < 40%) both for left or univentricular Prior hospitalization for acute heart failure within 1 year At least 2 prior hospitalization for acute heart failure Patients on waiting list for orthotopic heart transplantation (UNOS 1B,2) Informed consent obtained  Exclusion Criteria:  PMK or ICD hospitalized patients neurological or psychiatric impairment urgent waiting list for heart transplantation (UNOS 1A)