Project Summary There are 6 million people with heart failure in the United States with an expected 40% increase in prevalence in the next decade. Although advances in therapies allow for medical management of HF, patients often experience fragmented care, severe physical symptoms, psychological sequelae, existential distress, increased caregiving needs, complex end of life decision making, and financial concerns. Despite overwhelming evidence that early integration of palliative care effectively addresses these complex needs among HF patients, improves quality of life, and decreases hospitalizations, less than 10% of the six million patients with HF receive palliative care. If they do, it is often incorporated late in their disease trajectory. Palliative care should be integrated into traditional HF care based on patients’ perceived needs in any of the eight domains of palliative care which include physical, psychological, social, spiritual, cultural, ethical/legal, end of life, and care coordination needs. However, few studies have examined the unmet palliative care needs of patients with HF, particularly those who are physically frail. Because approximately half of all patients with HF are physically frail, there is a critical need to understand the unmet palliative care needs of physically frail patients with advanced HF. Further, we need to understand how higher unmet palliative care needs and physical frailty may interact to contribute to worse quality of life and increased odds of hospitalizations/mortality. However, no studies have investigated this phenomenon, creating a gap in our understanding of the potential impact of physical frailty and unmet palliative care needs on key HF outcomes. Using a prospective design, this study aims to investigate the associations of unmet palliative care needs and physical frailty with key HF outcomes among racially diverse, recently hospitalized, community-dwelling people with advanced HF. This will be accomplished through the following specific aims: Aim 1: Test the associations of unmet palliative care needs with key HF outcomes (health-related quality of life and 6-month all-cause hospitalization/mortality). Aim 2: Test the associations of physical frailty with key HF outcomes (health-related quality of life and 6-month all-cause hospitalization/mortality). Exploratory Aim: Test the interaction of physical frailty and unmet palliative care needs on key heart failure outcomes. Filling this gap in the science will provide foundational evidence to develop future interventions addressing the palliative care needs of physically frail patients with heart failure. The conceptual model of this study innovatively aligns with best-practice guidelines for palliative care and the National Institute for Nursing Research’s goal to conduct research which develops the most effective ways to screen, assess, and monitor the met and unmet palliative care needs of individuals with serious advanced illness and their fam...