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Promoting adherence to self-care illness management strategies among patients with heart failure (HF) has been associated with a number of positive health outcomes. Yet, little is known about health outcomes related to self-care in the "sickest of the sick"-those patients with advanced HF who are approaching the end of life. Clinicians and researchers must determine how self-care interventions are defined in the advanced HF population. For example, what is meant by self-care illness management in patients who are symptomatic with exertion may differ from that of patients who are predominantly symptomatic at rest. Our challenge is to develop the simplest, least burdensome self-care illness management interventions that target the most meaningful outcomes for patients, their families, and the healthcare system.