Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience

•Palliative care interventions designed for advanced, complex chronic illness aim to improve symptoms and quality of life, in part through medication management.•Few palliative care interventions report the effect of the intervention on patterns of polypharmacy, or the relationship of those patterns with quality of life.•In the Palliative Care in HF trial, polypharmacy was universal at enrollment, and the number of medications prescribed increased in both the intervention and standard care groups over time.•Although medications increased in both arms, patient-reported quality of life improved among those in the intervention arm compared with the control arm.•Appropriate polypharmacy may be an important contributor to quality of life for patients with heart failure receiving palliative care.