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Background Traditional physiologist-led follow-up for patients with cardiac resynchronisation therapy (CRT) often lack integrated care. Heart failure (HF) patients can face challenges with multiple clinic visits, delaying timely management. A pilot CRT Optimisation Pathway at University Hospitals Coventry and Warwickshire NHS Trust was introduced to integrate device optimisation, HF medication management, and arrhythmia care in the same sitting, aiming to improve patient outcomes.Methods This prospective study enrolled 83 patients at the CRT Optimisation Clinic. The pathway involved an initial 45-minute visit and follow-up after 4–6 months (34 in-person, 15 virtual), led by a HF specialist nurse and cardiac physiologist, with consultant support. Virtual follow-ups aided increase in first-visit appointment availability. Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) assessed quality of life (QoL). Historical care gaps were retrospectively compared with the new clinic intervention rate. Paired t-tests evaluated outcome measures between the initial visit and follow-up. The Biomedical and Scientific Research Ethics Committee granted ethical approval.Result Among the 83 patients (mean age 74.5 ± 10.4, 69.9% male, 56.6% with non-ischaemic cardiomyopathy), only 30.1% were on all guideline-directed HF therapies at baseline, reflecting historical under-treatment (table 1). The new clinic optimised HF medications in 62.6% at visit 1 (e.g., titration of beta-blockers and initiation of sodium-glucose co-transporter 2 inhibitors) and a further 55.1% at follow-up. In contrast, historical clinics only performed medication reviews in fewer than 24% of cases (figure 1). Optimisation of CRT occurred in 65%, reducing QRS duration by 9.76 ms (95% CI: -13.7, -5.8, p<0.001), with mean biventricular pacing at 96.7±4.04%. This average pacing rate remained stable at follow-up (96.9±3.76%, p=0.693), indicating sustained device efficacy. The clinic boosted referrals—community HF nurses (n=17) and arrhythmia service (n=6) which included DC cardioversion. Blood tests (e.g., NT-proBNP, iron studies) were also performed at visit 1, which guided IV iron referrals (n=12), a step absent historically. KCCQ-12 from the first to second visit showed improvement in physical limitation scores (mean +8.5 points, 95% CI: 1.1, 15.9, p=0.025) (figure 2), with NYHA IV cases dropping from 5 to 0. Notably, 70% of cases with improved KCCQ scores had device optimisation, and 73.3% had medication adjustments, highlighting the impact of integrated care. Conclusion The CRT Optimisation Pathway demonstrates feasibility and efficacy by offering robust device optimisation and holistic HF reviews in a single visit, associated with improvements in patient-reported outcomes and QoL. Its multidisciplinary, protocol-driven approach addresses gaps in historical care. Future studies should explore longer term outcomes, cost-effectiveness and scalability of this model to broader HF populations.Abstract 3-013 Table 1Baseline characteristics of patients who attended the CRT optimisation clinic Demographics Patients (n=83) Age (years), mean ± SD 74.5 ± 10.4 Male, n (%) 58 (69.9) Ethnicity White-British, n (%) 75 (90.4) Asian, n (%) 7 () Black, n (%) 1 (1.2) Weight (kg), mean ± SD 83.4 ± 19.2 Comorbidities Atrial Fibrillation, n (%) 34 (41.0) Stroke, n (%) 9 (10.8) Diabetes Mellitus, n (%) 25 (30.1) Chronic kidney disease III-V, n (%) 43 (51.8) Heart Failure Profile Ischaemic (%) 36 (43.4) Non-ischaemic (%) 47 (56.6) Ejection fraction (%), mean ± SD 28.7 ± 12.8 QRS duration (milliseconds), mean ± SD 141.3 ± 27.6 NYHA class I symptoms, n (%) 4 (4.8) NYHA class II symptoms, n (%) 33 (39.8) NYHA class III symptoms, n (%) 41 (49.4) NYHA class IV symptoms, n (%) 5 (6.0) KCCQ-2 summary score, mean ± SD 56.3 ± 25.9 Heart Failure Therapies CRT-D, n (%) 53 (63.8) CRT-P, n (%) 30 (36.2) Baseline biventricular pacing percentage, mean ± SD 95.6 ± 8.4 Medications Beta-blocker, n (%) 76 (91.6) Angiotensin converting enzyme inhibitor (ACEi), n (%) 25 (30.1) Angiotensin receptor neprilysin inhibitor (ARNI), n (%) 42 (50.6) Angiotensin receptor blocker, n (%) 10 (12.1) Mineralocorticoid receptor antagonist (MRA), n (%) 49 (59.0) Sodium glucose cotransporter inhibitor (SGLT2i), n (%) 43 (51.8) Loop diuretic, n (%) 55 (66.3) Amiodarone, n (%) 19 (22.9) Optimised on all heart failure medications, n (%) 25 (30.1) Abbreviations: CRT-D/P- cardiac resynchronisation therapy with defibrillator/pacemaker; KCCQ- Kansas City Cardiomyopathy Score; NYHA- New York Heart AssociationAbstract 3-013 Figure 1Comparison of intervention rates between the historical physiology-led CRT clinic and the integrated CRT optimisation clinic pathwayAbstract 3-013 Figure 2(Left) Change in QRS duration following CRT optimisation clinic (n=73); (Right) Comparison of KCCQ scores at initial visit and on follow-up (n= 48)