The committee considered that the cost of using a risk tool would be minimal in the majority of cases and would only require a few minutes of a consultation. Some risk tools required the additional cost of blood tests, but these also incur a very small cost ( 1- 3). The committee considered that in most patients the last year of life is when a patient is most likely to benefit from palliative care services, and is when these services are likely to be most cost effective. However, as the accuracy Chronic Heart Failure Advanced heart failure and palliative care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 of the risk tools identified in the clinical review was too uncertain to predict the last year of life for heart failure patients, the committee were concerned about the potential large cost implications of flooding the palliative care services. Therefore, the committee agreed that it was important that if a clinician is concerned that a patient may require palliative services, that they discuss this with the specialist heart failure team for a second opinion and to check if there are any other treatments available that could be tried first which would not require palliative care services. The committee considered that this would only likely require a telephone call, email or letter and would therefore not incur significant resource. If it was still considered that the patient could possibly benefit from palliative care services, they should then be referred for a needs assessment by the palliative care team as they are best placed to determine whether palliative services are required. 