47 Knowsley Trigger Tool - A Tool to Aid Identification of Heart Failure Patients Nearing End of Life and Promote Communication Between Heart Failure Specialist Nurses and Primary Care

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Despite advanced in diagnosis and medical therapies heart failure remains an incurable long term condition; with an increasing prevalence it has arguably the greatest impact on quality of life.The disease trajectory is often unpredictable with patients spending varying times in different phases of disease and episodes of clinical deterioration and death occurring at any time.It is appreciated that prognostication in heart failure is difficult with comorbidities playing a part. Difficulties in recognising end of life results in loss of opportunity to access palliative care and to address advanced care planning including discussions around future care and wishes. Recognising the need for a simple tool that holistically assesses the heart failure patient with regards to end of life was the motivation for the development of the “Knowsley Trigger Tool”.


Heart failure nurses and other healthcare professionals often have a “gut” instinct about a patients prognosis and a tool was designed to rationalise this and provide evidence of the consideration of end of life.A tool, using recognised end of life guidelines, was designed to consider prognostic indicators for end of life in heart failure, to give consideration to co-morbidities and patient wishes;with an aid to timely communication with other health professionals involved in the patients care. To evaluate, the tool was compared to the recognised “MAGGIC” prognostic indicator tool.Alongside usual care, including consideration of disease progression and end of life, over a 3 week period prognostic indicators were considered on all patients and both trigger tool and MAGGIC completed.

Results/conclusions and implications for practice

Total of 75 patients were reviewed with 32 triggering for consideration of end of life care when holistic assessment completed with trigger tool.When compared to MAGGIC score for the same patients there was a strong relationship between the two when considering predicted risk of death.Heart failure nurses found the tool easy to use with positive feedback regarding the consideration of comorbidities.Nurses found that the tool promoted good communication between nurses and other healthcare professionals.Further follow up studies are required with regards to the patients who were included to validate the tool further.

Results/conclusions and implications for practice

The tool has been embraced by the cardiac network and palliative leads; it is anticipated that it will form part of their guidelines for prognostic indicators in end of life in heart failure.Tool already features in community heart failure care pathway, prompting discussions and consideration of prognosis and end of life at initial review and at set periods during patient journey. Events to promote its use in primary care are in hand and it is hoped that the tool can be embraced by other health professionals to promote early recognition of end of life in heart failure and to allow for timely intervention and support.

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