A few patients in advanced or end-stage (stage D or NYHA functional class IV) heart failure are transplant or ventricular assist device eligible. Particularly for the non-operative patients (elderly or with significant comorbidities), intravenous palliative inotropes can be utilized for symptom control, for functional class and quality of life improvement. The authors report evidence-based medicine data about palliative inotrope therapy in advanced heart failure patients and they suggest a possible multidisciplinary approach in order to guarantee the best care to these patients.