Hoarding disorder (HD) is characterized by an accumulation of possessions owing to acquisition behaviors or absence of discarding, resulting in clutter severe enough to cause emotional distress, impair functioning, and preclude the use of living spaces for their intended purposes. HD is associated with significant psychiatric and physical health comorbidities. Evidence demonstrates an increased cardiovascular response, high prevalence of heart disease, and sudden cardiac death in patients with HD and yet treatment outcomes for patients with comorbid cardiovascular diseases remain unreported. A psychology referral was made for a patient with heart failure (HF) who underwent a structured clinical interview within their domicile and met criteria for adolescent‑onset HD (27‑year history). Treatment outcomes for this case are described, as well as the cognitive‑behavioral therapy (CBT) modifications required for the patient, living in squalor and facing eviction. Results demonstrated modest improvements in HD symptoms from pretreatment to posttreatment. To ensure HF patients are involved in sorting/discarding tasks during CBT, modifications are necessary to compensate for high fatigability and dizziness to reduce the risk for serious adverse events including syncope and falls.