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Aims Immune checkpoint inhibitors (ICIs) have transformed the management of advanced cancer, but are associated with significant adverse effects, particularly involving the heart. The ESC has published guidelines on identifying patients‘ risk of cardiac adverse events, and appropriately monitoring them. Despite this, formal risk stratification in clinical settings is rare, and clinical judgement is often used as a surrogate. This study aimed to assess whether cancer patients are being appropriately monitored whilst on ICI therapy, and determinants of monitoring quality.Methods This was a tertiary referral centre retrospective cohort study. Data on all patients receiving ICI therapy from 2019 to 2023 was extracted using hospital pharmacy dispensing records. Baseline demographic comorbidity and treatment data were collected to stratify patients as low or high risk as per ESC guidelines. Cardiovascular risk assessment was analysed at baseline and at established on-treatment checkpoints. The primary endpoint was completeness of cardiovascular risk assessment based on ESC risk category. Subanalyses were performed to account for the effect of age, gender, existent heart failure, and combination ICI therapy. Statistical analysis was performed using SPSS.Results 188 patients received ICI therapy– Mean age 64 (53–75), 61% male. 40.5% were high risk, 11% received combination ICI treatment. Median treatment time was 6 (3–12) cycles. Risk stratification quality was poor. Over the study period, high risk patients did not receive appropriate risk assessment either at baseline (p=0.47), or while on treatment (p=0.13). Patients who are older, on dual ICI therapy, or with existent heart failure are not monitored more stringently at baseline or on treatment. Women received less cardiovascular risk assessment preceeding treatment than men (p=0.021) ( figure 1).Conclusions High risk patients are not consistently identified by clinical judgement, screened appropriately at baseline, or monitored on therapy. Formal risk stratification is crucial to ensure the appropriate monitoring of this cohort.Abstract 62 Figure 1Bar graph demonstrating that completeness of recommended monitoring declines as duration of treatment progresses