Background: Studies indicate that the focus on patients with chronic heart failure is rehabilitative from a traditional understanding of treatment, in which the focal point is the effect of treatment relation to mortality, morbidity and health-related quality of life, whereby the palliative care is downgraded. Aim: To investigate which challenges and solutions the international research literature describes in relation to palliative care to the elderly with chronic heart failure. Method: A systematic literature review of international research literature inspired by Polit and Beck was carried out. The following databases were searched: PubMed, CINAHL, PsykInfo, Embase, Cochrane and SweMed. Thirty-seven articles were included. Results and conclusion: Health professionals find it difficult to predict the progress of the disease and are reluctant to initiate palliative care. Efforts are characterized by a lack of continuity and consistency, poorly coordinated care and problems in communication and transition between the primary and secondary sector. A two-pronged approach is proposed where palliation is offered alongside treatment to varying degrees according to need and the use of interdisciplinary/sectorial care plans, Golden Standards Framework and Advanced Care Plans. Furthermore a clear division of labour between health professionals is required.