ISBN: 978-1-4731-3093-7 10.4.7 Recommendations and link to evidence Recommendations Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure MDT and consider a needs assessment for palliative Research recommendation What is the most accurate prognostic risk toos in predicting 1 year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Relative values of different outcomes The committee were interested in which validated risk tools best identified patients with heart failure who are at increased risk of all-cause mortality in the short term (up to 1 year). The aim was to identify tools that may be used to support decisions about involvement of palliative care services and the use of palliative care processes. It was recognised that the risk of death was only one factor to consider in determining the need for palliative care services and processes, but that accurate prognostic tools would be of value in the identification and decision-making process. The committee did not intend that risk tools would be used to specifically estimate the number of years that a person may live, or as a criterion for palliative care referral. The committee agreed that all-cause mortality was the appropriate outcome, rather than heart failure or cardiovascular mortality, in the context of the broad objectives of this review question. 