Advanced heart failure (AHF) is the late stage of the heart failure syndrome that is associated with significant morbidity, high mortality, and rising costs that pose a significant burden for the different health care systems in the United States and worldwide. Despite advances in pharmacologic and device therapy, patients with AHF frequently require complex therapies, such as continuous infusion with inotropic agents, mechanical circulatory support, and heart transplant. This article summarizes the team-based approach to care of patients with AHF and those supported by left ventricular assist devices.