Millions of people worldwide have heart failure. Despite enormous advances in care that have improved outcome, heart failure remains associated with a poor prognosis. Worldwide, there is poor short-term and long-term survival. The 1 year survival following a heart failure admission is in the range of 20-40% with between-country variation. For those living with heart failure, the symptom burden is high. Studies report that 55 to 95% of patients experience shortness of breath and 63 to 93% experience tiredness. These symptoms are associated with a high level of distress (43-89%). Fewer patients experience symptoms such as constipation (25-30%) or dry mouth (35-74%). However, when they do, such symptoms are associated with high levels of distress (constipation: 15-39%; dry mouth: 14-33%). Psychological symptoms also predominate with possibly as many as 50% experiencing depression. Palliative care services in heart failure are not widely available. Even in countries with well-developed services, only around 4% of patients are referred for specialist palliative care. Many patients and their families would benefit from receiving specialist palliative care support.