This chapter explores the role of palliative care in the management of patients with advanced cardiovascular disease, emphasizing symptom relief, quality of life, and holistic patient-centered care. It highlights common symptoms such as dyspnea, pain, fatigue, and psychosocial distress and offers practical strategies for their assessment and management in heart failure, refractory angina, and end-stage cardiomyopathies. The chapter underscores the importance of early integration of palliative principles alongside curative treatments, effective communication about prognosis and goals of care, and shared decision-making with patients and families. It also addresses advanced care planning, ethical considerations, and coordination with multidisciplinary teams to navigate complex interventions such as device deactivation and transplant candidacy. This guidance equips hospitalists to deliver compassionate, comprehensive care that aligns with patients’ values and improves quality of life in advanced cardiac illness.