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Introduction Cardio-oncology services play a key role in preventing, detecting, and managing cardiovascular complications of cancer therapy. European Society of Cardiology cardio-oncology guidelines emphasise the importance of streamlining cardiovascular risk stratification, baseline assessment, treatment surveillance and long-term follow-up. These services enable early identification of cancer therapy-related cardiac dysfunction (CTRCD), optimisation of cardioprotective therapy, and safe continuation of cancer treatment when appropriate. We aimed to evaluate the activity and impact of a novel tertiary cardio-oncology service.Methods We retrospectively examined patients referred to a cardio-oncology service at Queen Elizabeth Hospital, Birmingham, from April 2022 to March 2025. Baseline measurements included cancer therapy, cardiovascular risk factors, cardiac biomarkers, imaging, assessment of left ventricular ejection fraction (LVEF), evidence of CTRCD, and use of cardioprotective agents. All patients were seen in a specialist clinic and management optimised in line with contemporary guidance. Follow-up assessment included repeat cardiac biomarkers, LVEF, and changes in cardioprotective agents. All statistical analyses were performed using SPSS Statistics (IBM Corp, US).Results 160 consultations (51% female; mean age 54.3 ± 18.5 years) were performed in a dedicated cardio-oncology clinic. Temporal trends showed an evolving service demand (8 referrals in 2022 versus 18 in 2025), with haematological malignancy (37%; n=27/73) and reduced LVEF (85%; n=62/73) being the commonest reasons for referral ( figure 1). Median time from referral to first appointment was 58 days (IQR 3.75-88.5 days). Investigations performed at baseline pre-referral were variable: N-terminal pro-B-type natriuretic peptide or NTproBNP (64%, n=47/73), troponin (33%; n=24/73), and LVEF assessment (94%, n=69/73). After median follow-up period of 335 days (IQR 201-513 days), this improved in all metrics measured: NT-proBNP 73% (n=53/73), troponin 36% (n=26/73), LVEF assessment 96% (n=70/73). Increased use of cardioprotective agents was seen during the course of follow up (figure 2). There was concurrent improvement in mean LVEF, from 39.1% (± 13.2%) at baseline to 46.6% (± 13.8%)(p<0.001). Overall, 96% of patients were able to complete cancer treatment without transient interruption.Conclusion A dedicated cardio-oncology service enabled optimisation of cardioprotective agents, improvement in LVEF and high rates of completion of cancer treatment. However, prolonged wait times and variable baseline investigations indicate a need for broader stakeholder engagement and service expansion.Abstract 185 Figure 1Cancer types of all patients referred to the cardio-oncology serviceAbstract 185 Figure 2Percentage of patients on cardioprotective drugs at baseline and at their most recent follow-up. There was a statistically significant increase in the use of ACE-Inhibitors / ARBs, Beta Blockers, SGLT-2 Inhibitors, and Entresto at follow-up, compared to baseline (* = p-value < 0.05). ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; MRA, mineralocorticoid receptor antagonist; SGLT2, sodium-glucose co-transporter 2.