PURPOSE OF REVIEW: Advanced heart failure (HF) is characterized by high symptom burden, poor quality of life (QoL), and recurrent hospitalizations. As survival improves, an increasing proportion of patients progresses to advanced stages, leading to a growing population of individuals with end-stage HF, many of whom are ineligible for heart transplantation or mechanical circulatory support due to age, comorbidities, frailty, or limited social support. This review aims to synthesize current evidence on palliative care (PC) integration in advanced HF, focusing on indications, timing of referral, and the role of multidisciplinary care in optimizing patient management. RECENT FINDINGS: Recent evidence supports early integration of PC across the HF trajectory, demonstrating reductions in hospital readmissions and improvements in QoL. Screening tools, patient reported outcome measures, and frailty assessments have emerged as key instruments to identify unmet needs and appropriate referral. Multidisciplinary models involving cardiology, palliative specialists, nurses, and community care providers have shown benefits in symptom control, care coordination, and advance care planning. PC represents a fundamental component of advanced HF management and should be integrated early in the disease trajectory. A structured, multidisciplinary approach that supports holistic care, improves patient outcomes, and aligns treatment strategies with patient preferences should be routinely adopted by HF clinicians.