An inverted (intussuscepted) appendix is a rare finding, often mistaken for a polyp as it presents with vague symptoms. This can result in misdiagnosis and inappropriate management. Diagnosis is usually made through surgery. Rarely, endometriosis has been found as the cause of the intussusception. A 42-year-old woman presented with frequent loose stools over 2 years, an elevated calprotectin over 400 μg/g faeces (normal <110) and a serum C-reactive protein of 40 mg/l (normal <5 mg/l). Endoscopy showed an inverted appendix. Histopathology results showed inflammation and ulceration. Laparoscopic appendicectomy was performed successfully, and endometriosis was found on the inverted appendix. This is the first case reported of an inverted appendix containing endometriosis, in which the intussusception of the appendix has been diagnosed on endoscopy. This case highlights how endometriosis can involve just the appendix, without any involvement of reproductive organs. We suggest considering inverted appendix as a differential diagnosis when investigating caecal lesions.

Aim To investigate European Society of Cardiology (ESC) Guidelines' 'typical' and 'less typical', and 'non-ESC' symptoms associated with heart failure, and ESC typical and less typical symptoms regarding setting, age, and sex. Methods A mixed-method systematic review and narrative synthesis. Systematic search was carried out in six electronic databases. Quality was assessed using Joanna Briggs Institute (JBI) critical appraisal checklists. Symptoms were grouped into typical and less typical, and non-guidelines symptoms. Differences in typical and less typical symptoms were investigated in hospital versus community settings, <65 versus 65 years old age, and men versus women. Results 37 papers (26 quantitative, 8 qualitative and 3 mixedmethod research) were included. 62% of participants were male. Mean age was 66 (48-82). Participants in 36 studies reported at least one of 6 typical, whereas less typical (n=10) and non-Guidelines n=37) symptoms were observed in 35 and 37 studies, respectively. Most observed symptoms of each group were: Breathlessness (typical-78%, n=3659); cough (less typical-48%, n=3450); and lack of energy (non-ESC-69%, n=1758). Less typical symptoms (cough, wheezing, palpitation, and dizziness) were different between hospital and communitydwelling cohorts. Typical symptoms (orthopnoea, paroxysmal nocturnal dyspnoea, and swelling) were higher in cohorts 65 years old age. Due to the paucity of women's perspectives in studies, there was little information available to compare the symptom experiences of men and women. Conclusion A comprehensive individual symptom assessment will be required to provide more focused and person-centred care. Thus, clinical management guidelines should include the full spectrum of symptoms in different phases of heart failure (especially, palliative and end of life care).

Conclusions This secondary data analysis has illustrated out-ofhours services are highly used up to midnight, particularly by patients' family and carers. Recommendations to commissioners and service providers:• Ensure telephone services are available between 5pm and midnight.• Prioritise family and carers in the design of out-of-hours telephone services.• Undertake further research with patients and families to understand when home visits or telephone calls are appropriate to meet patients' needs.