To describe the symptoms experienced in the last year of life by people with heart disease, their relation to quality of life, and informal carers' satisfaction with hospital services. Interview survey of informal carers of 600 patients aged 15 and over, approximately ten months after their death from heart disease in 1990 in 20 English health districts. The districts, while self-selected, were nationally representative in social characteristics and indicators of health service provision and use. Pain, dyspnoea and low mood were reported to have been experienced by more than half the patients in their last year of life. Anxiety, constipation, nausea/vomiting, urinary incontinence and faecal incontinence, although not suffered by the majority of patients, also caused much distress. Hospital symptom control was reported to be limited: little or no symptom relief was reported for 35% patients with pain, 31% with constipation, 24% with dyspnoea and 24% with nausea/vomiting. Nevertheless, high levels of satisfaction with hospital staff were reported. Patients dying from heart disease experience a wide range of symptoms, which are frequently distressing, and often last for more than six months. There is room for an improvement in palliative care for patients with heart disease in hospital.