The complexities of managing heart failure among employees have not been studied. In this mixed methods study, the authors explored how cognition, physical functioning, attitudes, and self-efficacy influence self-care among employees with heart failure. Forty-one adults (White, 68.3%; male, 63.4%; median age, 51 years; employed, 48.8%) completed in-depth interviews and standardized instruments. Content analysis was used to derive themes from narrative accounts of self-care practices, attitudes, and self-efficacy within the context of employment. Descriptive and nonparametric statistics were used to describe the sample and generate hypotheses about relationships among the variables. Most of the employed participants (N = 13) worked full-time (65%), primarily in sedentary jobs. Cognition and physical functioning were better in those who were employed (p = .02), but self-care practices were lower (p = .03). Those who successfully managed heart failure and work described strategies to incorporate self-care into their workdays, self-efficacy in managing symptoms while at work, and favorable attitudes toward employment.