Heart failure is a significant healthcare burden on both a national and global scale. Placement of an implantable device such as LVAD or TAH may be recommended for patients whose heart failure has worsened beyond the reach of standard medical therapy, as a bridge to transplant or destination therapy. Consideration for this intervention must include evaluation of the patient’s cognitive and psychological functioning, as cognitive deficits or severe emotional issues may negatively impact treatment success. Patients with heart failure may struggle with significant psychological issues such as depression and anxiety, which may become severe and impact their participation in treatment both prior to and following device placement. Other diagnoses such as PTSD and personality disorders can also affect treatment adherence and impact patient relationships with the treatment team. Neuropsychological evaluation of the potential MCS candidate is highly recommended as many heart failure patients struggle with illness-related cognitive deficits that can also affect their participation in treatment, but also to identify patients with progressive neurocognitive disorders that preclude MCS. The neuropsychologist is positioned to provide important, specific information regarding these aspects of patient functioning to guide treatment decisions and recommendations, to inform and educate the treatment team, to help patients and their caregivers understand the factors that may impact their treatment course, and to provide intervention and support through all stages of MCS treatment.