{
  "abstract": "Background Advanced heart failure (HF) is associated with high symptom burden, frequent hospitalisation and complex shared decision-making, yet palliative input is often late and fragmented. National and international guidance endorses needs-based integration of palliative care alongside cardiology; however, published evaluations of joint cardiology–palliative clinics remain limited and typically report small cohorts with low contact intensity. A joint cardiology–palliative care clinic was established at KEMP Hospice, and this abstract reports a service evaluation focusing on service design, outcomes and benchmarking against published models and national guidance.Methods A retrospective service evaluation was conducted of all patients referred between January 2023 and July 2020. Routinely collected electronic clinical data were analysed, including demographics, HF phenotype, comorbidities, New York Heart Association (NYHA) class, guideline-directed medical therapy, device therapy and deactivation, clinic attendance and outcomes. Survival from first clinic attendance to death or discharge was analysed using Kaplan–Meier methods.Results Thirty-two patients were reviewed (mean age 78.2 ± 8.7 years; Charlson comorbidity index 7.8 ± 2.7)( table 1). Median NYHA class at referral was III, indicating advanced symptomatic disease (table 2). Most patients had HFrEF with a high prevalence of atrial fibrillation and chronic kidney disease (table 1). Median clinic attendance was four visits, suggesting sustained longitudinal engagement compared with previously reported hospice-based joint clinic models (table 2). Kaplan–Meier analysis demonstrated a median survival of 443 days from referral, indicating a meaningful window for proactive symptom management, medication review and advance care planning in line with national guidance. Four patients had CRT-D devices; three underwent defibrillator deactivation following multidisciplinary review and shared decision-making.Conclusion A hospice-based joint cardiology–palliative care clinic is a feasible and effective service design for managing advanced HF. Use of routinely captured clinical data enabled objective assessment of service utilisation, survival and device deactivation, providing measurable indicators of integrated care delivery that are often under-reported in published service evaluations. This scalable, data-enabled multidisciplinary model has potential to inform regional service design and improve coordinated care for patients with advanced heart failure.Abstract 551 Figure 1Abstract 551 Table 1Baseline characteristics of the study population (N = 32)CharacteristicValueAge at referral, years78.2 ± 8.7Male sex22 (64.7%)Female sex10 (31.3%)Atrial fibrillation22 (64.7%)Hypertension9 (26.5%)Prior myocardial infarction6 (17.6%)Valvular heart disease9 (26.5%)Moderate–severe chronic kidney disease17 (50.0%)Charlson comorbidity index7.8 ± 2.7Abbreviations: AF = atrial fibrillation; CKD = chronic kidney disease.Note: Values are presented as n (%) unless otherwise stated. Continuous variables are reported as mean (SD) or median, as appropriate. Percentages for place of death are calculated among deceased patients only.Abstract 551 Table 2Clinical outcomes and service utilisation (N = 32)OutcomeValueAlive at last follow-up2 (6.3%)Discharged from service6 (18.8%)Deaths24 (75.0%)Place of death – hospital16 (66.7%)Place of death – home8 (33.3%)Clinic attendances, median4NYHA (median)III",
  "authors": [
    {
      "affiliations": [
        "Worcester Royal Hospital, Worcester, United Kingdom"
      ],
      "name": "Queenett Brinemugha"
    },
    {
      "affiliations": [
        "Worcester Royal Hospital, Worcester, United Kingdom"
      ],
      "name": "David Wilson"
    }
  ],
  "title": "551 Design and evaluation of a joint cardiology–palliative care clinic for advanced heart failure: a hospice-based service evaluation and benchmarking against published models and national guidance",
  "uid": "9bfadfaa-2b03-5693-b658-5f2c60c1a19c"
}