The need for people with heart failure to have access to palliative care is well recognized. There is consensus that the best way to effect this is to provide palliative care alongside and integrated with interventions appropriate to the heart failure itself. However, barriers to this working out in practice remain, and many sufferers and their carers continue to bear the burden. Recognizing the transition to end-stage disease seems to be a key problem; clinicians are concerned about the uncertainty of predicting poor prognosis. A problem-centred approach -that is, one that accords with need or capacity to benefit rather than one that depends on diagnosis or clear prognosis -appears to be useful. This article suggests certain triggers that may be used to initiate a full supportive and palliative care assessment in order to identify patient problems that could be alleviated with palliative support.