Background End stage heart failure (HF) is associated with significant symptoms, multiple preventable hospital admissions and high mortality. Palliative care (PC) improves symptoms, quality of life and reduces hospitalisations without increasing mortality for patients with end stage HF. Despite this, patients with HF are less likely to access hospice services. The newly published framework for integrated care systems, ‘Addressing palliative and end of life care needs for people living with heart failure’ lists the measures needed to improve cardiac supportive PC for people with end stage HF. One of the key requisites listed is that PC must be included in the core membership of the HF MDT. A PC Consultant from Farleigh Hospice has been part of the weekly primary and secondary care HF MDT for the last 2 years. A joint clinic with HF and PC clinicians for symptom management was also set up at a local community hospital. Data was analysed to understand the benefit for HF patients.

Methods Referrals to the hospice were analysed. Number of patients with primary diagnosis of HF (i.e. the main reason for referral to hospice) was compared with patients with both primary and secondary diagnoses of HF as a baseline.

Results Referrals for patients with a primary diagnosis of HF increased by 50% in the last 2 years compared to 41% for those with other diagnoses including HF. The covid pandemic saw a huge increase in referrals which dropped briefly before increasing again. When this peak period is taken as a baseline, referrals for HF patients have increased by 57% compared to 13% for those with primary and secondary diagnoses. The number of HF patients admitted to the inpatient unit for EOLC in the last 12 months increased sixfold from 1 to 6.

Conclusion Collaborative working across teams with PC as a core member of local HF MDTs has been instrumental in enabling more people with end stage HF to receive high quality palliative and end of life care.