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Introduction Infective endocarditis (IE) remains a challenging disease to diagnose with multi-system involvement and high morbidity and mortality rates. Multi-disciplinary team (MDT) management within a dedicated ‘Endocarditis Team’, including cardiologists, microbiologists, and infectious disease specialist is a class I recommendation within the European Society of Cardiology 2023 guidelines. 1 An extensive evidence base has demonstrated the impact of MDT management on multiple performance metrics, including mortality rate.2–7 A dedicated weekly endocarditis MDT was introduced in March 2024 at Royal Liverpool Hospital. We present the activity report of the MDT since its introduction.Methods Retrospective observational study of all patients referred to the endocarditis MDT over the past 2 years at Royal Liverpool Hospital. Data collected included patient demographics, classification of IE according to Duke’s criteria (i.e. definitive, possible and rejected), MDT recommendations (i.e. antibiotic change/duration/dose, investigations, surgical referrals), number of times patients discussed, number of patients who underwent surgery, length of stay, and mortality rates (overall, 30 days and 1 year). Multivariable regression modelling was used to examine relationships between clinical indices and outcomes, while adjusting for baseline differences of subject.Results Of the 226 cases, there were a total of 48 cases of definite IE, 49 cases of possible IE and 129 cases rejected as per the Duke’s criteria. Overall, there were a total of 55 (24%) deaths, with 26 (11.5%) occurring within 30 days and an additional 29 (12.8%) occurring within a year. Most deaths occurred in the ‘rejected’ group (11%), with a significant association between this group and overall mortality (p= 0.021). Followed by 8% in those with possible IE (p = 0.022). No significant association was found between definite IE and mortality (p=0.062). Mortality rates were also highest amongst patients with positive blood cultures for staphylococcus aureus (p<0.001). However, no significant association was seen between mortality and sex (p = 0.767), age (p = 0.07), or length of hospital stay (p = 0.93).Conclusions Among those with definite and possible IE, 30-day mortality rate was 15.5%, and 1-year mortality rate was 16.5%, both lower than those reported in some previous studies, 8 9 potentially reflecting the value of MDT management in facilitating timely diagnosis and improving outcomes.References Delgado V, Marsan NA, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023. Oct 14;44(39):3948–4042. Doi: 10.1093/eurheartj/ehad193.Camou F, Dijos M, Barandon L, Cornolle C, Greib C, Laine M, et al. Management of infective endocarditis and multidisciplinary approach. Med Mal Infect. 2019;49:17–22. https://doi.org/10.1016/j.medmal.2018.06.007 37.El-Dalati S, Cronin D, Riddell JT, Shea M, Weinberg RL, Washer L, et al. The clinical impact of implementation of a multidisciplinary endocarditis team. Ann Thorac Surg. 2022;113:118–124. https://doi.org/10.1016/j.athoracsur.2021.02.027 38. Elad B, Perl L,Hamdan A, Yahav D, Atamna A, Shaked H, et al. The clinical value of the endocarditis team: insights from before and after guidelines implementation strategy. Infection 2022;50:57–64. https://doi.org/10.1007/s15010-021-01636-3 39.Gibbons EF, Huang G, Aldea G, Koomalsingh K, Klein JW, Dhanireddy S, et al. A multidisciplinary pathway for the diagnosis and treatment of infectious endocarditis. Crit Pathw Cardiol. 2020;19:187–194. https://doi.org/10.1097/HPC.0000000000000224 40.Kaura A, Byrne J, Fife A, Deshpande R, Baghai M, Gunning M, et al. Inception of the ‘endocarditis team’ is associated with improved survival in patients with infective endocarditis who are managed medically: findings from a before-and-after study. Open Heart 2017;4:e000699. https://doi.org/10.1136/openhrt-2017-000699 41.Ruch Y, Mazzucotelli JP, Lefebvre F, Martin A, Lefebvre N, Douiri N, et al. Impact of setting up an “endocarditis team” on the management of infective endocarditis. Open Forum Infect Dis. 2019;6:ofz308. https://doi.org/10.1093/ofid/ofz308 42. European Committee on Antimicrobial Susceptibility Testing.Rajani R, Klein JL. Infective endocarditis: a contemporary update. Clin Med (Lond). 2020;20(1):31 35. doi:10.7861/clinmed.cme.20.1.1Abegaz TM, Bhagavathula AS, Gebreyohannes EA, Mekonnen AB, Abebe TB. Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis. BMC Cardiovascular Disorders 2017 Dec;17(1).