[15,16]This may be due to the high rate of co-morbidities among this relatively elderly population. Palliative care provision should be according to need. Referral criteria and care pathways for this patient population need to take account of the complexities of prognostication and incidence of sudden death. [17] Palliative care planning that takes account of preferences and family support may reduce the number of unplanned admission among Inhibitors,research,lifescience,medical CHF patients (an internal audit [unpublished data] found that within the Hospital 22% of discharged heart failure patients

were readmitted within 30 days). Conclusion We propose referral criteria based on this data, mindful that referrals should not rely on end-of-life or terminal stages, as earlier intervention may optimise quality of life. Our proposed criteria are reproduced Inhibitors,research,lifescience,medical in Figure ​Figure22. Figure 2 Proposed referral criteria to palliative care for patients with Chronic Heart Failure. Our conservative measurement of the magnitude of need suggests that 4.4% of medical, vascular surgical and care of the elderly hospital inpatients have clinically diagnosed CHF and require palliative care, therefore adequate generalist and specialist skills are required within the acute setting. We propose the present criteria as a means

to Inhibitors,research,lifescience,medical ensure optimal quality of life for patients with CHF according to need rather than disease progression. Competing Gamma-secretase inhibition interests The authors declare that they have no competing interests. Authors’ contributions RH designed the study, secured funding, managed data collection/analysis and drafted the manuscript. TB assisted design, secured funding, recruited subjects, Inhibitors,research,lifescience,medical assisted in interpretation and commented on drafts. FH was a member of the project group, recruited patients, assisted in interpretation and commented on drafts. EC was a member of the project group, Inhibitors,research,lifescience,medical recruited patients, assisted in interpretation and commented on drafts. MK was a member of the project group, participated in interpretation and commented

on drafts. LS was a member of the project group, participated in interpretation and commented on drafts. IH was a member Mephenoxalone of the project group, assisted design, assisted in interpretation and commented on drafts. All authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-684X/8/8/prepub Acknowledgements We are grateful to all the clinical staff that assisted us in conducting this study. We thank Guy’s & St Thomas’ Charitable Foundation for supporting this study with a service development grant.
GPs refer relatively few patients from these migrant groups to home care. They often find it difficult to assess the needs of these patients and their families.