@article {Atkinsonbmjspcare-2021-003378, author = {Clea Atkinson and Sian Hughes and Len Richards and Victor MF Sim and Julie Phillips and Imogen J John and Zaheer Yousef}, title = {Palliation of heart failure: value-based supportive care}, elocation-id = {bmjspcare-2021-003378}, year = {2022}, doi = {10.1136/bmjspcare-2021-003378}, publisher = {British Medical Journal Publishing Group}, abstract = {Objectives Heart failure (HF) is a prevalent condition associated with poor quality-of-life and high symptom burden. As patients reach ceilings of survival-extending interventions, their priorities may be more readily addressed through the support of palliative care services; however, the best model of care remains unestablished.We aimed to create and evaluate a cospeciality cross-boundary service model for patients with HF that better provides for their palliative care needs in the latter stages of life, while delivering a more cost-effective patient journey.Methods In 2016, the Heart Failure Supportive Care Service (HFSCS) was established to provide patient-centred holistic support to patients with advanced HF. Patient experience questionnaires were developed and distributed in mid-2018 and end-of-2020. Indexed hospital admission data (in-patient bed days pre-referral/post-referral) were used allowing statistical comparisons by paired t-tests.Results From 2016{\textendash}2020, 236 patients were referred to the HFSCS. Overall, 75/118 questionnaires were returned. Patients felt that the HFSCS delivered compassionate care (84\%) that improved symptoms and quality of life (80\% and 65\%). Introduction of the HFSCS resulted in a reduction in HF-related admissions: actual days 18.3 to 4 days (p\<0.001), indexed days 0.05 to 0.032 days (p=0.03). Cost mapping revealed an estimated average saving of at least {\textsterling}10 218.36 per referral and a total estimated cost saving of approximately {\textsterling}2.4 million over 5 years.Conclusion This service demonstrates that a cospeciality cross-boundary method of care delivery successfully provides the benefits of palliative care to patients with HF in a value-based manner, while meeting the priorities of care that matter to patients most.All participants are aware that the results of this project would potentially be published, quoted presented and be made publicly available. N/A.}, issn = {2045-435X}, URL = {https://spcare.bmj.com/content/early/2022/07/04/bmjspcare-2021-003378}, eprint = {https://spcare.bmj.com/content/early/2022/07/04/bmjspcare-2021-003378.full.pdf}, journal = {BMJ Supportive \& Palliative Care} }