BACKGROUND: Despite the increasing recognition of palliative care in the management of heart failure (HF), many patients continue to experience unmet care needs due to the delayed integration of supportive services. Identifying these needs is crucial for enhancing patient-centered care and informing healthcare policies. This qualitative study aimed to explore the palliative care needs of patients with HF. METHODS: This qualitative study employed a directed content analysis approach. Semi-structured in-depth interviews were conducted with 22 adult patients with heart failure in Ahvaz, Iran. Data collection continued until saturation, ensuring no new themes emerged. To ensure the trustworthiness of the findings, Lincoln and Guba's criteria were used. RESULTS: A total of 22 adult patients with heart failure participated in the study, with a mean age of 58.45±18.07 years. Data analysis revealed eight main categories of needs, including 'care structures and processes', 'physical aspects', 'psychological aspects', 'social aspects', 'cultural aspects', 'end-of-life care', 'ethical and legal aspects' and 'spiritual and existential aspects' with 30 subcategories. CONCLUSION: This study highlights the urgent need for early and thorough palliative care in heart failure management. By meeting patients' diverse needs with team-based, patient-focused methods, we can enhance quality of life, manage symptoms better and reduce healthcare challenges. These results are important for clinical practices and policies, supporting the creation of specialised palliative care programmes for heart failure patients.