Prognostication or identification of palliative needs in advanced heart failure: where should the focus lie?

Heart failure (HF) is a significant public health issue with high morbidity and mortality despite persistent advances in therapeutic strategies. HF is physically and psychologically burdensome for patients and their families and costly to the NHS; the latter driven primarily by repeated prolonged hospital admissions.1 The greatest incidence and prevalence of HF is in older patients. The multiple and often complex comorbidities associated with this cohort impact on management strategies and prognosis.2 The 1-year survival following a new diagnosis of HF is invariably poor, but the decline towards death is often unpredictable. This chaotic illness trajectory contributes to what has previously been termed, ‘prognostic paralysis’.3 Consequently, anticipatory management is extremely difficult and so a ‘revolving door’ clinical pattern often ensues. It is now accepted that the morbidity and mortality for patients with HF is similar to or worse than many cancers with the first HF hospitalisation in particular heralding a very poor prognosis.4 Despite this, end of life care in HF remains uncoordinated and inadequate for many. As such the development and validation of a HF score to permit accurate identification and prognostication in this group is an attractive prospect clinically and in terms of resource allocation. In this issue of Heart , Haga et al 5 identified two scores for comparison: the qualitative Gold Standards Framework Prognostic Indicator Guide (GSF)6 and the better …