Heart failure (HF) is a chronic and incurable disease evolving toward a terminal phase. More than 300 000 Canadians suffered from HF. Patients with a severe form of HF (phase IV, according to the New York Heart Association) have a one year survival of 50 %. Palliative care has been extensively developed over the last years for the benefit of the cancer patient, these cares emphasizes a biopsychosocial approach that includes quality of life, pain control and symptoms relief at the end of life. Unfortunately, palliative care is rather poorly offered to the people suffering from a non malignant condition. Many authors stated that the symptoms of HF failure patients are quite similar to those observed for palliative cancer patients. The Montreal Heart Institute (MHI) has integrated a palliative care approach according to the Quebec policy on palliative care. This palliative care approach contributes to the quality of care and promotes the patients and clinicians satisfaction.