Advanced heart failure (AHF), which has been defined as symptoms limiting daily life [New York Heart Association (NYHA) class III or IV] despite previous therapy with angiotensin converting enzyme inhibitors (ACEI), diuretics, digoxin and more recently β-adrenergic receptor blockers when tolerated, 6 is said to account for about 25% of the diagnosed heart-failure population.2 Patients with left ventricular ejection fraction (LVEF) less than 25% are said to have AHF if they conform to previous therapy as stated above.2 Here, ACE is linked to advanced heart failure.