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Introduction Acute decompensated heart failure (ADHF) is a leading cause of hospitalisation. Intravenous (IV) diuretics are central to ADHF management. The European Society of Cardiology (ESC) guidelines for heart failure (HF) recommend starting IV furosemide at a daily dose equivalent to 1–2 times the daily oral dose pre-admission. This study aims to assess adherence to these guidelines and its impact on outcomes.Methods This was a retrospective analysis of patients admitted to a large academic hospital, with ADHF, between March and December of 2024. Patients with known HF, on maintenance loop diuretics prior to admission were included. Those with a new diagnosis of HF, not on oral loop diuretics pre-admission were excluded. Data collected were baseline characteristics, loop diuretics prescribed on admission and outcomes. Statistical significance was calculated with Student’s T-test and Fisher’s exact test.Results 63 patients were included. Mean age was 77.0±11.1 years and 59.4% were male. Table 1 summarises the baseline characteristics. The average NT-proBNP was 7003 ng/L, and 93.7% of patients were prescribed furosemide. 71.4% received an adequate dose of loop diuretics and 28.6% were inadequately diuresed. Figure 1 details the pre-admission diuretic doses. Only 46.0% of patients received a higher dose of diuretics than their baseline. There was a significantly higher weight reduction by day 3 of hospitalisation in the appropriate group (1.84±2.18kg vs 0.37±1.13kg, p=0.0009), and shorter hospital stay (15±14 days vs 32±25 days, p=0.015). There was a higher incidence of acute kidney injury in the inappropriate group (38.9% vs 26.7%, p=0.158), though this was not statistically significant.Conclusion Nearly one third of patients admitted with ADHF received an inadequate dose of loop diuretics, which correlated to poorer outcomes. This highlights a need for interventions, such as clinician education and electronic dose calculators, to bridge guideline-practice gaps.Abstract 78 Table 1Baseline characteristicsAbstract 78 Figure 1Daily equivalent of oral furosemide pre-admission in the appropriate and inappropriate groups