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The World Health Organization defines Quality of life (QOL) as an individual's perception of their position in lfe in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. During chronic heart failure several factors contribute to the alteration of QOL: congestion, dyspnea, fatigue, sleep disturbances, anxiety, depression, side effects of medications, impacts on personal life and disruption of social interactions which can modify patients' social roles, life situation and ability to travel. NYHA class, exercise tolerance represent physician-reported patient well-being parameters but do not actually assess alterations expressed by the patient. There are several specific instruments to better evaluate QOL: they can be generic (self-assessment of general well-being), health related QOL (SF36), specific to diseases (Minnesota Living With Heart Failure Questionnaire) or domain specific (anxiety, depression). Impact of ACE inhibitors, angiotensin 2 antagonists, and beta-blockers are small while that of cardiac resynchronization and multidisciplinary management programmes are more efficient. In advanced heart failure when patient recognize equal importance between improvement in QOL and gain in survival, left ventricle assist devices (LVAD) significantly improve QOL at early (3 months) and long-term (2 years) follow up. LVADs allow the rapid return of the patients at home and genuine autonomy in the context of a personalized care plan supervised by the referring centre. Beneficial effects are close to those of heart transplantation but still are limited by the need of taking care of their equipment.