Moderate quality evidence was found for a single study (n=676) reporting on an untitled risk tool which combined data from the 6MWT and NT-proBNP. This tool reported a moderate c-statistic of 0.68. Moderate quality evidence was also found for a further 2 studies which reported on the Heartmate II risk score (n=11,523) and the 3C-HF score (n=4258). The Heartmate II risk score showed a moderate sensitivity of 0.59, while the 3C-HF tool reported a good c-statistic of 0.82 (0.81-0.83). Further moderate quality evidence was found for an untitled risk tool reported in 2 studies (n=2176). Both studies reported moderate discrimination statistics of 0.71 (0.67-0.76) and 0.76. A single very low quality study reported the prognostic accuracy of the AHEAD tool which reported a moderate c-statistic of 0.63. Although several of the studies met the minimum AUC threshold, only a single study reported the sensitivity and specificity of two tools at the relevant mortality thresholds of interest. These statistics provide more accurate insight into the ability of the tool to adequately stratify peoples risk of mortality at 1 year. Economic No relevant economic evaluations were identified. 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 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. 