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Background Breathlessness is a common presenting symptom of multiple cardiovascular diseases, including heart failure and valve disease. Using national UK primary care data, we previously identified higher rates of unplanned hospitalisation but lower likelihood of diagnosis following initial presentation with breathlessness in patients of South Asian and Black ethnicities compared to White ethnicity. To explore these trends in more depth a qualitative study was conducted to explore how breathlessness is experienced, interpreted and acted upon within culturally diverse communities.Methods Community-specific focus groups with members from Bangladeshi, Pakistani, Punjabi, Gujarati, Somali, African and Carribean backgrounds were conducted in the city of Leicester, with interpreter support where required. A topic guide was developed with input from our patient advisory group, with representatives from the target communities, and used to facilitate discussions. Focus groups were audio-recorded and transcribed verbatim and translated where applicable. Transcripts were coded and organised into themes using a thematic analysis approach, allowing patterns across groups to be identified.Results Eight focus groups with a total of 51 participants (5-8 participants per group) were conducted. Two overarching themes around conceptualising breathlessness and how decisions to seek healthcare are made were found. Breathlessness was frequently perceived as frightening and often framed in fatalistic terms, but also as an expected symptom as a part of ageing in the Punjabi community ( figure 1). When translated into other spoken languages by participants, it was commonly expressed using multi-word phrases rather than a single equivalent term, with Bangladeshi participants describing an overlap with the term used for Asthma (‘hapani’). Across groups breathlessness was frequently experienced alongside sweatiness, fatigue and palpitations, with Punjabi, Bangladeshi and Pakistani communities emphasising heaviness or tightness in the chest, whilst heaviness or ‘choking’ in the throat was reported in the African community. Severity, duration and worsening symptoms were described as cues to action across all groups. Delays were driven by lack of trust and low confidence in perceived benefits of from seeking healthcare among African and Caribbean groups, and lack of awareness in linking breathlessness to serious underlying disease in the Bangladeshi and Punjabi groups (figure 1).Conclusion The findings suggest the experience of breathlessness is influenced by cultural interpretations and healthcare-seeking behaviours are shaped by degree of confidence in healthcare and symptom awareness. These factors should be taken into account in healthcare delivery. There is a clear need to improve recognition of breathlessness as a potential marker of serious underlying disease within communities, in order to support timely and appropriate healthcare access.Abstract 366 Figure 1Participants quotes illustrating parceptions of breathlessness and health seeking behaviours