Background Despite optimal medical management, only 65% of patients with NYHA IV heart failure (HF) are alive at an average follow up of 17 months. Prognosis is difficult to anticipate because HF has an unpredictable trajectory. HF teams are under increased pressure locally due to extension of commissioned work to include HF with preserved ejection fraction. Whatever the aetiology, symptom burden is high and quality of life can be poor for patients and carers. The holistic, multi-disciplinary approach of palliative care means that it can improve symptom control and quality of life and reduce hospital admissions. The Hospice has worked collaboratively with HF teams in the community and secondary care to develop services meeting these objectives including; outpatient/community review with signposting to appropriate services, MDT support, administration of IV iron, inpatient unit admission for symptom control, offloading fluid, rehabilitation and end of life care and carer support.

Method Referrals into each service were reviewed along with the source of referrals. IPOS was administered and analysed to look at the impact of care delivered

Results Between January 2018 to November 2022, 162 referrals were made for 142 patients, 76 male, 66 female, average age 81yrs (range 32 to 104 years). There has been a rapid rise in referrals to all services across the Hospice since 2018. Of these, 65 patients have died since October 2020. Less than 14% of patients died in hospital. 40% referrals came directly from the community HF team, 22% from GPs and 24% from hospital.

IPU Community Medical review IV iron

2022 22 16 7 22 (to 31/10/22

Conclusion Collaboration between the Hospice and community and secondary care heart failure teams has facilitated referral into Hospice services and enabled us to support this vulnerable group of patients and their carers. More work needs to be done to reach out to GPs to make them aware of the services offered.