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Continuous use of PDE5Is According to the EMA, a once-daily regimen with tadalafil 2.5 or 5mg may be considered suitable, based on patients choice and physicians judgement

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The answer may be tucked into the highlighted portion of that quote above - "or death presumed to be cardiac in origin." You see, from the outset, it never was intended that the EPIC Trial's pre-heart-failure administration of pimobendan end at death

Extracellular vesicles from Akkermansia muciniphila protect streptozotocin-induced diabetic mice by regulating glucose homeostasis, oxidative stress, and immune tolerance