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Introduction Carcinoid heart disease (CHD) is a sequelae of metastatic carcinoid neuroendocrine tumours (NETs) and is a major cause of morbidity and mortality. It can be rapidly progressive, and so early recognition is key to successful management. It has been proposed that patients with metastatic NETs should have annual measurement of NT-proBNP and should have echocardiography to look for CHD if this level is >260 ng/L.Aims To review the proportion of patients with metastatic NET known to one tertiary referral centre screened with NT-proBNP levels before and after the introduction of a CHD pathway ( figure 1). A second aim was to calculate the incidence of CHD in the cohort and examine whether using the CHD pathway could have aided an earlier diagnosis in each case.Methods Chart review of 221 patients with a diagnosis of NET discussed at a regional meeting between March 2017 and December 2022. Follow up data was collected from NET clinics completed between 30/09/2024 and 22/11/2024.Results On initial audit 124 patients were identified as being at risk of developing CHD. 59 (47.6%) patients had NT-proBNP measured within the preceding year and only 25 patients (20.2%) had annual measurements completed. 35 patients (28.2%) had a documented NT-proBNP of >260 ng/L. 50 patients at risk of CHD with were seen at NET clinics between 30/09/2024 and 22/11/2024 following the introduction of the CHD pathway. 35 (70.0%) of these patients had NT-proBNP measured. In the follow-up cohort 7 patients (20.0%) were found to have NT-pro BNP >260 ng/L and 6 (85.7%) were appropriately referred for echo. 11 patients in the cohort had evidence of CHD and 10 of these patients died during follow-up. In the 10 patients who died mean survival following the diagnosis of CHD was 1.22 years (range; 0.35 – 5.04 years). 9 of these patients (88.9%) had NT-proBNP values above 260 ng/L (mean value 1,989 ng/L). It may have been possible to identify CHD earlier in 5 (45.5%) of these 11 cases with the use of a CHD pathway.Abstract 1-028 Figure 1The belfast health and social care trust carcinoid heart disease pathwayConclusion NT-proBNP is a useful screening tool for the detection of CHD in patients with metastatic NETs. A pathway can aid the early detection of CHD and in turn could have the potential to improve outcomes in this patient group.