Based on this evidence, the committee discussed whether the tool could be used as a rule out tool, to identify those patients who were unlikely to need a palliative care needs assessment. However, the committee agreed that the main focus of the review was to positively identify patients who may benefit from palliative care services and processes, not to rule out patients, and decided that a recommendation to use the tool in this way would not be appropriate. The MAGGIC risk score was also reported in multiple studies, with an AUC ranging from 0.69 to 0.78. Again, the committee could not be sure that the tool would meet the minimum threshold for AUC of 0.70, especially when the confidence intervals around the AUC estimates were considered. Sensitivity and specificity data on this tool was available from the same large cohort mentioned above. Similarly to the SHFM, the sensitivity of the tool was very low (3.1%) and the specificity high (99.2%) at the clinically relevant threshold of 50% predicted mortality. Sensitivity at the threshold of 20% predicted mortality was somewhat higher (69.7%), indicating that at this threshold, the tool identified most of the patients who were at higher risk of death. However, at this threshold the MAGGIC score also labelled a 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 significant proportion of patients as at high risk of death who did not die within the year ( false positives ) (the specificity of the tool was only 61%). The MAGGIC data was also at high risk of bias due to poor calibration, suggesting that the absolute predicted risks from the tool did not align well with the observed risks in the population. 