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Introduction The European Society of Cardiology recommends that care of Adult Congenital Heart Disease (ACHD) patients should ideally occur in a specialist centre. 1 ACHD services in Northeast England comprises a tertiary specialist centre in Newcastle upon Tyne with referral centres across the region. Patients typically receive care at multiple hospitals and present to their local centre in emergencies, making access to up-to-date ACHD information crucial for emergency practitioners.As such, it would be important to evaluate if these patients are identified as ACHD patients on local systems and their common cardiac presentations in emergency settings.Methods This study was a retrospective analysis of 330 ACHD patients followed up at the regional tertiary specialist centre who have a Teesside or Darlington postcode, between January 2022 to December 2024.We searched the local electronic database (LED) in South Tees Hospitals Trust for:Clinic letters from the regional centreAny local clinic follow-up lettersEmergency care attendancesNumber of patients attending South Tees emergency care servicesNumber of attendances to emergency care services in totalNumber of attendances with cardiac symptoms defined as:Chest painDyspnoeaPalpitationsSyncopeAttendances resulting in cardiac diagnosesResults 124 patients (37.6%) had no local records available ( figure 1).Of 206 patients with available records:71 patients (34.5%) attended emergency services.49 of 185 attendances (26.5%) presented with cardiac symptoms9 of 185 attendances (4.9%) resulted in a cardiac diagnosis and over half of them (55%) with tachyarrhythmias (table 1).Abstract 1-027 Figure 1Abstract 1-027 Table 1 Cardiac Diagnoses Attended with cardiac symptoms Number of diagnoses Tachyarrhythmias 88NSTEMI11Prosthetic Valve Infective Endocarditis01Conclusions Currently over a third of the patients have no records available at South Tees Hospitals TrustOur data reflects available literature with regards to high utilisation of emergency services and over half of the attendances presenting with tachyarrhythmias.2 Recommendations have been made to create an IT flag system in our local emergency services for ACHD patients and for the regional centre’s clinic letters to be uploaded locally to create a better system of information sharing to help in management of these patients.References Baumgartner H, De Backer J. The ESC clinical practice guidelines for the management of adult congenital heart disease 2020. European Heart Journal 2020 Oct 30;42(6).Chessa M, Brida M, Gatzoulis MA, Diller GP, Roos-Hesselink JW, Dimopoulos K, et al. Emergency department management of patients with adult congenital heart disease: a consensus paper from the ESC working group on adult congenital heart disease, the European society for emergency medicine (EUSEM), the European association for cardio-thoracic surgery (EACTS), and the association for acute cardiovascular care (ACVC). European Heart Journal 2021 May 21;42(26):2527–35.