Introduction Multiple hospital admissions are a common feature of advanced heart failure(HF), accounting for significant healthcare expenditure. Admissions are often precipitated by increasing breathlessness, and inpatient intravenous diuretics are administered. Collaboration between specialist palliative care(SPC) and HF services locally resulted in a specialist led service able to provide, monitor and titrate subcutaneous(sc) diuretics in the community.

Aims To determine patient and carer views • To identify potential demand for the service. To calculate cost savings.

Methods 1. A focus group of HF patients and their carers. 2. All patients in the supportive and palliative phase of HF under a single cardiologist (DS) were identified. 3. A cost analysis was performed based on the knowledge that any patient given sc diuretics would previously have been admitted.

Results The focus group uniformly welcomed the service. • In 1 year, 56 patients were identified who may be suitable for the service in the future (only 17 required SPC review). • 13 patients (mean age 76.9, NYHA IV) received s/c diuretics, 6 at home and 7 in the hospice. Total number of episodes of treatment was 27. Of the 6 patients who have died, 5 died in the hospice and 1 at home. • The total predicted cost using the tariff for heart failure with complications and comorbidities was £112203. The total cost of community services (including input by all nurses, GPs and SPC services including hospice admissions) was £70916. This is a cost saving of £41287 for all 13 pts.

Conclusion A specialist led community based subcutaneous diuretic services is welcomed by patients with end stage heart failure and has the potential to deliver significant cost savings.