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. Based on this data, the committee agreed that the MAGGIC tool would also not be an appropriate tool for positively identifying patients who may benefit from palliative care assessment. The remaining tools considered in the review were all only considered in single study cohorts, and none of them provided sensitivity or specificity data. The AUC for these tools ranged from 0.59 to 0.82. The committee discussed the 3C-HF tool, which was the only tool in the review with an AUC of above 0.80. The committee agreed that while the overall AUC was high, without data on the tool s performance at clinically relevant thresholds for identifying high risk patients (for example, the sensitivity and specificity of the tool at a threshold of 50% predicted mortality within 1 year), combined with the fact that the tool was only validated in a single study cohort, they would not be comfortable recommending the tool for assessing individual mortality risk. Overall, the committee agreed that the evidence did not support the use of any of the identified prognostic risk tools to identify heart failure patients at high risk of mortality. The committee also discussed the potential for serious harm from inappropriate use of risk tools in the palliative care context. Incorrectly categorising a person at high risk of death could have negative consequences for that person and their family. Further, if the tools were misused as a criterion for access to palliative care services that would also cause substantial harm, given they fail to identify many of the patients who may benefit from such interventions. 