Background Patients with heart failure are as likely to be symptomatic with advance care planning needs, however, on average make up only 4% of hospice and palliative care teams’ caseload. An application for a grant for a pilot service was made to St James’s Place Charitable Foundation.

Aims

• To provide integrated assessments of patients with a primary diagnosis of heart failure who were felt to be in the last year of life;

• Focus on advance care planning and symptom management;

• Provide clinical education on heart failure and palliative care.

Method Through meetings with relevant staff including hospice, local community and hospital NHS Trusts, we developed a service plan, referral criteria-protocol for a targeted, joint (palliative care physician and Heart Failure Clinical Nurse Specialist) intervention with appropriate onward referral and a ‘Palliative Care in Heart Failure’ conference.

Results The clinical service ran for 13 months: 41 referrals and completed 35 first assessments. 77% were seen at home (home or nursing/residential home) reflecting the poor functional status of many of these patients. 86% of patients had medication changes made at the first assessment. Of the patients seen 85% had a Preferred Place of Care/Preferred Place of Death recorded following assessment and 65% achieved this. Further qualitative evaluation by a local university will provide more detailed information regarding benefit.

The ‘Palliative Care in Heart Failure’ conference was held on 15 November 2018 with 51 attendees. There were speakers on a range of relevant topics (including external experts) and 98% of attendees rated it highly.

Conclusion This pilot has increased the number of patients with heart failure accessing hospice services, and by raising awareness of the needs of these patients will continue to do so.