Many of the patients had significant physical and palliative care needs such as pain, dyspnoea, oedema, and psychosocial needs with approximately one-third having more than five hospital admissions in the past 2 years. Table 1 outlines the palliative care needs of participants.Despite these significant needs, only one-third (69) of the patients had been referred to the palliative care team with only about one-quarter (58) of patients having integrated care plans in place. Furthermore, a third of the patients had no advance care plan in place or do-not-attempt-cardiopulmonary-resuscitation (DNACPR) decision, and a similar proportion had no escalation/ level of care decisions documented. Also, 20.1% of patients had a cardiac device in situ, of which 5.1% were implantable cardiac defibrillators (ICDs); however, only 2.2% of patients with ICDs had an end-of-life device plan in place. In addition, despite nearly 29% of patients having a documented preferred place of end-of-life care, this was only achieved in 12.7% of cases. ConclusionPatients with advanced heart failure have significant physical and palliative care needs which remain largely unmet as evidenced in this study. We recommend an integrated heart failure-palliative care MDT be introduced trust-wide with referral triggers to include NHYA stage III and IV symptoms despite optimal therapy and complex physical and psychosocial needs. Finally, we recommend that heart failure palliative care be the subject of regular quality improvement strategies.