|Chronic heart failure very often gets worse over time. It can be hard to think and talk about the type of care you want at the end of your life. Many people who have heart failure die of the condition. However, discussing these subjects with your doctors and loved ones may help bring you peace of mind. Heart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure). Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. End-stage heart failure has one of the largest effects on quality of life of any advanced disease. Patients living with serious illness have identified the following as their top-priority needs from the healthcare system: adequate pain and symptom management, avoidance of inappropriate prolongation of dying, achievement of a sense of control, relief of the burden on others, and a strengthening of relationships with loved ones. Although heart failure patients are often assumed principally to suffer from fatigue and dyspnea, a majority have pain, and depression is extremely common. Other sources of suffering include edema, insomnia, anxiety, confusion, anorexia, and constipation. Palliative care improves outcomes, including patient and family satisfaction with care and symptom management.20â26 Patients who receive in-home palliative care are more likely to die at home. This is consistent with the expressed wishes of most patients.