{
  "abstract": "Background Despite growing recognition of palliative care needs in advanced heart failure (HF) patients, knowledge gaps persist regarding the clinical phenotype, symptom burden and healthcare utilisation of this population. 1 2 This limited understanding impedes effective service planning. As part of NHS England’s ‘Managing HF@Home’ initiative,3 a local HF palliative care programme was piloted, enabling the evaluation of baseline characteristics, quality of life (QoL) metrics and healthcare utilisation to inform targeted palliative care strategies.Methods We enrolled 100 patients to the community palliative care programme. QoL was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) and EQ-5D-5L, with 72 completing both questionnaires. Logistic regression examined associations between KCCQ scores and healthcare utilisation, with ROC analysis for significant findings. A general linear model identified any predictors of low KCCQ scores.Results The cohort was predominantly elderly (mean age 75.6±13.1), male (61%) with 46% having HFrEF, 35% HFpEF and 19% HFmrEF. Most were highly symptomatic (87% NYHA III-IV) and severely frail (median Hospital Frailty Risk Score 10 and Charlson Comorbidity Index ≥5 in 61%). Median unplanned all-cause hospitalisation in the six months preceding referral were 1 (IQR 3) and 55% required GP or nurse input in the past month. HF diagnosis exceeded 1–5 years in 65% before referral. KCCQ results revealed severe QoL impairment (median clinical summary score 33/100, IQR 25; overall score 32/100, IQR 27). Severe-to-extreme difficulties were reported in usual activities (71%), mobility (48%), self-care (32%), pain/discomfort (11%) and anxiety/depression (10%). The KCCQ overall score showed fair predictive ability for increased primary care use (AUC 0.7, p=0,0241) and HF-related admissions (AUC 0.7, p=0.0368). A KCCQ score <42 was associated with increased primary care reliance, while <48 correlated with HF-related hospitalisation. These thresholds had 77–78% sensitivity, but moderate specificity (53–56%). NYHA class independently predicted KCCQ summary scores (β=-12.5, p=0.009), whereas age, comorbidity burden, frailty, LVEF and HF duration were not significant predictors.Conclusion This study highlights the profound symptom burden, frailty and high healthcare utilisation in palliatively managed HF patients, with increasing referrals of patients with preserved LVEF. Despite long-standing HF, referrals are often late, missing opportunities for proactive palliative care interventions. KCCQ-based thresholds may help identify high-risk patients while its association with NYHA class underscores functional status as a key factor in guiding palliative care timings. A comprehensive model should prioritise individualised symptom management alongside functional rehabilitation, integrating physiotherapy and occupational therapy to enhance mobility, independence and daily living in this vulnerable population.Abstract 3-007 Table 1Baseline characteristics of patients referred to community HF palliative careClinical Phenotype (n=100) Age (yrs)- mean (SD ) 75.6 (13.1) Gender (Male %) Male (62%), Female (38%) Ethnicity- (%) Caucasian (90%), Asian (10%) HF diagnosis- (%) HFrEF (46%), HFmrEF (19%), HFpEF (35%) Duration of HF diagnosis > 1 to 5 years (39%), >5 years (26%) NYHA class- (%) NYHA II (13%), NYHA III (73%), NYHA IV (14%) Baseline LVEF- mean (SD ) LVEF 40% (10%) Charlson Comorbidity Index- median 5 (IQR 3–6) Hospital Frailty Risk Score- median 10 (IQR 8–12) Abbreviations and definitions: HFrEF: Heart failure with reduced ejection fraction (LVEF <40%), HFmrEF: HF with mildly reduced ejection fraction (LVEF 41–49%), HFpEF: HF with preserved ejection fraction (LVEF ≥50%); LVEF: Left ventricular ejection fraction; NYHA: New York Heart AssociationAbstract 3-007 Table 2Quality of life metrics of patients referred to community HF palliative careQuality of Life Metrics (n-=72) KCCQ Scores Median (IQR ) Physical limitation 25 (12.5 – 43.8) Total Symptom Score 44 (28.1 – 57.2) Clinical Summary Score 33 (25.7 – 50.2) Overall Summary Score 32 (21.2 – 47.8) EQ-5D-5L Dimensions (n=72) Degree of impairment Mobility Moderate (39%), Severe (39%), Extreme (9%) Self-care Moderate (37%), Severe (26%), Extreme (6%) Usual Activities Moderate (19%), Severe (59%), Extreme (12%) Anxiety/Depression Moderate (40%), Severe (6%), Extreme (4%) Baseline overall health Median score 50 (IQR 40–65) Abbreviations and definitions: EQ-5D-5L: EuroQoL-5 Dimensions-5 Levels; KCCQ-23: Kansas City Cardiomyopathy QuestionnaireAbstract 3-007 Figure 1(Top) Forest Plot of multivariate regression analysis showing that NYHA was a significant predictor of a low KCCQ score; (Bottom) ROC analysis showing moderate predictive ability of KCCQ score on healthcare utilisation (primary and secondary care)References NHS England. Addressing Palliative and End of Life Care Needs for People Living with Heart Failure. 29 Aug. 2023, https://www.england.nhs.uk/long-read/addressing-palliative-and-end-of-life-care-needs-for-people-living-with-heart-failure/. Accessed 13 Feb 2025.Ripamonti CI, Chelazzi C. Is palliative care in heart failure patients coming up? Eur J Heart Fail. 2023 Oct;25(10):1856–1858. doi: 10.1002/ejhf.3002.NHS England. Managing Heart Failure @home Information for Patients. 8 Feb. 2023,https://www.england.nhs.uk/long-read/managing-heart-failure-home-information-for-patients/. Accessed 13 Feb 2025.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire NHS Trust, UK"
      ],
      "name": "Stephanie Kirkland"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire NHS Trust, UK"
      ],
      "name": "Patrick Tran"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire NHS Trust, UK"
      ],
      "name": "Prithwish Banerjee"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire NHS Trust, UK"
      ],
      "name": "Michael Kuehl"
    }
  ],
  "title": "3-007 Defining the palliative heart failure population: insights into symptom burden, quality of life and healthcare utilisation for evidence-based service planning",
  "uid": "48d60659-1f50-5f35-b00b-db33335e668a"
}