This study illustrates that people with advanced HF are a hidden population due to a lack of databases containing clinical information, therefore their informal caregivers are an even harder to reach population. No official register of informal caregivers, caring for HF patients in Northern Ireland or the Republic of Ireland exists; they have been described as “invisible” to healthcare systems. Such informal caregivers are caring for their loved one 24-7 and are often responsible for making the decision to seek medical assistance, when the patient’s health worsens. HF patients require their informal caregivers support to manage symptoms and recognise signs of deterioration. Findings from this research suggest caring for a patient with advanced HF can have a significant impact on the caregiver’s overall QoL and they have a number of unmet needs. Caregivers expressed the need for improved service provision in the clinical care of their loved one, emotional support for them to cope with their caregiving role, improved communication from healthcare professionals and support communicating with the patient. The difficulties caregivers reported in the current study were predominantly related to poor communication from healthcare providers, whom reportedly do not always acknowledge the role informal caregivers play. Current caregivers expressed fear regarding “the future” and bereaved caregivers reported, on many occasions healthcare professionals did not encourage open channels of communication relating to the deteriorating condition of their loved one. A palliative approach should be adopted by healthcare professionals involved in the care of people living with HF, introducing aspects of palliative care early in the patient’s disease trajectory and then making referrals to specialist palliative care services when the patient is in the advanced stage of their illness. For successful integration of HF and palliative care services, roles and responsibilities for members of the multidisciplinary team need to be established. The training needs of healthcare professionals responsible for the care of patients living with advanced HF need to be addressed, to ensure they have the necessary communication skills to initiate sensitive conversations surrounding advance care planning (ACP) and the poor prognosis that’s inevitable in HF. Research is warranted to determine whether implementation of ACP in the care of people living with HF has the potential to address uncertainty and support the patient-caregiver dyad.