Heart disease is the leading cause of death in the developed world and causes significant morbidity and repeated hospitalization. Heart failure (HF) is the final common pathway for many cardiovascular diseases. Although optimal medical management and targeted use of devices improve survival and quality of life for people with HF, symptom distress and other types of illness burden are common. High illness burden and the risk of sudden death at every stage of HF means that palliative care treatments should be integrated into care for all patients. Palliative care should enhance communication among clinicians and with the patient and family, and should provide options for treatment of symptoms and deactivation of devices. Simultaneous care by a cardiologist and a palliative care specialist may optimize outcomes, and palliative care specialists must be aware that referral to HF specialists may be necessary for patients with advanced HF. Integrating palliative care alongside HF care can improve quality of life, decrease suffering and healthcare costs, and enhance quality of care.