The committee emphasised that involvement of palliative care services and use of palliative care processes includes a broad spectrum of interventions, and that different levels of care and support can be provided at various stages of the person s disease pathway. People should be reassured that use of palliative care processes does not necessarily mean referral to a hospice or the withdrawal of prognostic heart failure medication, and that people can dip in and out of palliative care over the course of their disease. The committee acknowledged that palliative care processes do not necessarily require delivery by specialist palliative care doctors and nurses. For example, GPs, geriatricians and heart failure specialist nurses may be specially trained to implement palliative care processes for heart failure patients. The committee agreed that people with heart failure and their family and carers should have access to professionals with palliative care skills within the specialist HF MDT, and all specialist HF MDTs should have access to specialist palliative care services and should involve those services where necessary. Future research The committee discussed the need for studies of prognostic risk tools in heart failure to report accuracy data (such as sensitivity, specificity and negative and positive predictive values) at specific clinically relevant thresholds, in order for the data to inform decisions about the value of the tools at an individual level in clinical practice. The committee decided that this was a priority for future research in this area and made a research recommendation to that effect. Trade-off between net clinical effects and costs No previously published economic evaluations were identified comparing different risk tools. 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. 