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Introduction 200,000 new cases of heart failure (HF) are diagnosed annually in the UK, with cases expected to double by 2040. Acute HF is a leading cause of hospitalisation over 65s, with 50% five-year mortality rate after first HF hospitalisation. Timely treatment reduces morbidity and mortality, with urgency of diagnosis reflected in guidelines. NICE recommend transthoracic echo (TTE) within 2 weeks if N-terminal pro-B-type natriuretic peptide (NT-proBNP, hereafter ‘BNP’) is >2000 ng/l, or within 6 weeks if BNP is 400 – 2000 ng/l. At our centre, which serves a population of 544,000, we identified the need to improve our HF diagnostic pathway.Method Launched in 2022, the Rapid Access Heart Function Clinic (RAHFC) provides a one-stop BNP-gated service for suspected HF, akin to a two-week-wait cancer pathway. All referrals are triaged by a HF clinician, with uncontrolled atrial fibrillation and established HF excluded. Audits were conducted in Autumn 2021 (pre-RAHFC) and 2023 (post-RAHFC) to evaluate wait times to TTE and HF clinician review. All referrals into general cardiology outpatients over a 2-month period were screened. Referrals mentioning signs/symptoms of HF, raised BNP and/or abnormal TTE were included in audits, alongside those explicitly stating a differential of HF.Results In 2021, 97 referrals with possible HF were received over 2 months. In 2023 there were 103. The majority were referred by a GP (91% in 2021, 82% in 2023) with the remainder from other specialities, A&E or ambulatory care. In 2021, 44% had BNP >400 ng/l, with 28% <400 ng/l and 27% unknown. In 2023, 59% had BNP >400 ng/l, with 10% <400 ng/l and 31% unknown. In the ‘BNP unknown’ group, around a third had TTE prior to referral. Of referrals with BNP >400 ng/l (n 105), 45.7% were diagnosed with HF (25.7% had ejection fraction <50%). The remainder had other cardiac (30.5%) or non-cardiac (21%) diagnoses. For patients referred by a GP or as an outpatient from other speciality, median wait time to TTE (days) reduced from 152.0 (IQR 37.0 – 250.0, n 59) to 23.5 (IQR 13.8 – 38.3, n 68) ( figure 1 and figure 2). Wait time to clinician review (days) reduced from 121 (IQR 33.5 – 130.5, n 71) to 27 (IQR 18 – 68.25, n 78). In 2023, 26 patients (28% of those seen) were seen in the RAHFC, with median wait time 18 days (IQR 15 – 28).Abstract 5-005 Figure 1Median time to TTE pre RAHFC (2021)Abstract 5-005 Figure 2Median time to TTE post RAHFC (2023)Conclusions RAHFC implementation was associated with a reduction in TTE and clinician review wait times, improving timely HF diagnosis and treatment. Whilst post-pandemic recovery is an important confounder, reduced wait-time variability reflects better standardisation. Over half referred with possible HF and BNP >400 ng/l had a non-HF diagnosis, highlighting challenges in triaging. Further work will focus on improving awareness of the service and ongoing collaboration with care of the elderly colleagues to optimise our approach in frailer patients.