Heart failure (HF) is a common chronic condition, increasing in prevalence in line with an ageing population. Patients have a significant symptom burden, and a palliative care approach may be appropriate in advanced disease. Barriers to a palliative care approach exist, but can be overcome by an integrated model of care. Palliative care of patients with advanced HF has many similarities to palliative care of cancer patients. It is important to assess the psychosocial and spiritual domains of symptoms such as breathlessness, as well as physical. Individually tailored medical management has transformed the care of HF, but in advanced disease management the cardiac medication should be regularly reviewed to ensure optimal tolerated doses are prescribed. Breathlessness is a common and distressing symptom for patients with HF and their families. Specific non-pharmacological interventions such as exercise and psychological interventions should be considered. Pharmacological strategies, particularly low-dose opioids may also be useful. Use of oxygen remains a clinical uncertainty. Usefulness of cardiac devices, particularly implantable cardioverter-defibrillators decreases in advanced disease. Deactivation requires excellent communication between teams and with patients and families.