A strategy for managing heart failure based exclusively on conventional treatment results in the majority of patients having inadequate symptom control, a poor quality of life and uncoordinated care. The Scottish Partnership for Palliative Care report Living and dying with advanced heart failure: a palliative care approach advocates that these problems should be addressed by the integration of conventional and supportive care; at present this rarely happens. The report’s main recommendations are summarised and their relevance to the natural history of heart failure discussed for the benefit of the general and care of the elderly physicians who are responsible for the in-hospital management of more than 80% of heart failure patients. The recommendations are equally relevant to primary care teams. The problems to be addressed when devising a strategy to implement the recommendations are outlined.
