Specialty palliative care in advanced heart failure is an emerging area of clinical practice. Nurses play a key role in providing in- and outpatient palliative care for these patients and their families. This chapter provides an overview of advanced heart failure for the palliative care nurse at all levels of practice. Topics discuss underlying pathophysiology and causes of advanced heart failure, clinical manifestations and staging, assessment and diagnostic findings, pharmacologic and nonpharmacologic management, heart failure devices, symptom management, and advance care planning. Many of these topics are summarized in brief, and hence clinicians are encouraged to refer to cited sources for more in-depth discussion that may be appropriate for individual settings and patient populations.