AIMS: Explore the experience of living with fatigue in persons with advanced heart failure. DESIGN: Single-setting, qualitative interview study. METHODS: In-depth interviews were conducted from November 2012 - June 2013. Participant responses to open-ended questions were analysed using thematic analysis. INCLUSION CRITERIA: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction and able to participate in interviews in their own language. Exclusion criteria was cognitive deficit Twenty-three participated in the study. RESULTS: Participants (age 72.5 ± 9.5 years, 10/23 female), identified experiencing fatigue daily with 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. CONCLUSION: As heart failure progresses fatigue influences patients' daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations.