As ap- proaches to management continue to evolve, readers are encouraged to follow the scienti c literature for updated evidence and recommendations for optimal management of these patients. 5.10. How to Integrate Palliative Care and Transition to Hospice Care Advances in care have delayed the progression of disease but rarely lead to a cure, such that the palliative care needs of patients, caregivers, and healthcare systems are as great as ever. Most palliative care is provided by non- palliative care specialists. Accordingly, such clinicians shoulder the primary responsibility for coordinating an end-of-life plan consistent with values and goals expressed by patient and family. The following are important points to consider regarding palliative care and transition to hospice. Principle 1: Palliative care strives to reduce suffering through the relief of pain and other distressing symptoms while integrating psychological and spiritual aspects of care. Action: Soliciting goals of care and focusing on quality of life are appropriate throughout the clinical course of HF and become increasingly important as the disease progresses. Principle 2: Good HF management is the cornerstone of symptom palliation. Maddox et al. 