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Introduction Optimisation of guideline-directed medical therapy (GDMT) remains the cornerstone of improving clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and preserved EF (HFpEF). A standardised approach to assess and report GDMT optimisation may improve patient outcomes. First described in 2020, the Heart Failure Collaboratory Medical Therapy Score assessed the use and dosing of evidence-based therapies but did not include Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i) or ivabradine and was restricted to HFrEF.We have here introduced the Blackpool Heart Failure Medical Therapy Score, aligned with NICE 2020 guidance, integrating core evidence-based therapies, with ethnicity-specific considerations, and extending to HFpEF.We tested the hypothesis that a low Blackpool Heart Failure Medical Therapy Score is associated with a worse prognosis.Methods In this single-centre observational study of patients presenting with decompensated HF, the Blackpool Heart Failure Medical Therapy Score was assessed.For patients with HFrEF, the score assigns 2 points for ≥50% of the target dose and 1 point for <50% of the target dose for angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), angiotensin receptor–neprilysin inhibitors (ARNI), and beta-blockers. Two points are assigned for any dose of a mineralocorticoid receptor antagonist (MRA) and an SGLT2 inhibitor. Additional points (1 point for <50% and 2 points for ≥50% of the target dose) are allocated for ivabradine in patients in sinus rhythm with a heart rate ≥70 bpm, and for hydralazine–isosorbide dinitrate in Black patients. This yields a maximum achievable score ranging from 8 to 12.The final score is expressed as a percentage by dividing the total score achieved by the maximum attainable score for that individual, as determined by ethnicity, heart rate, and cardiac rhythm.For patients with HFpEF, the score comprises 2 points each for any dose of MRA and SGLT2i therapy, with a maximum of 4 points.Primary outcome: composite of all-cause hospitalisation or death within 30 days of discharge.For statistical analysis, continuous variables are presented as median [IQR] or mean (SD), depending on whether the variable is normally distributed. Kaplan-Meier survival analysis was performed using SPSS.Results 119 patients with HF were included in this study. Mean age was 75 (SD 13). 60 are female (50%). 92 (77%) are Caucasians. 43 (36%) had ischaemic aetiology. 11 (9%) had CRT/ICD device therapy. Table 1 shows other baseline characteristics.72 patients had HFrEF. 44/72 (61%) had Blackpool HFrEF Medical Therapy Score 50% or more. 18 of 37 patients (49%) with HFpEF had HF score 50% or more.Nineteen of the 72 HFrEF patients died or were readmitted within 30 days (primary composite outcome). A low Blackpool HFrEF Score was associated with a significantly increased risk of death or hospitalisation (primary outcome; p = 0.033; figure 1). On the other hand, in the relatively small cohort with HFpEF, only 7 of 37 patients died or were readmitted within 30 days. The Blackpool HFpEF score does not predict higher risk of death or hospitalisation.Patient Public Involvement (PPI) coauthor comment: This score can motivate patients to take their medications correctly, especially if they know how much it may improve outcomes.Conclusion Low Blackpool heart failure with reduced ejection fraction score is associated with an increased risk of death or hospitalisation. The Blackpool heart failure with reduced ejection fraction score may support personalised optimisation of guideline-directed medical therapy and help identify patients at higher risk at the point of hospital discharge. Future research will evaluate whether an increase in score between baseline and 30-day follow-up is associated with improved one-year survival after accounting for comorbidities.Abstract 282 Figure 1Kaplan Meier curve showing lower HF score (HFrEF) is associated with worse all-cause hospitalisation or mortality at 30 days (p= 0.033)Abstract 282 Table 1Baseline characteristicsN (%)ECG rhythmSinus 61 (51%); AF 57 (48%)Heart rate bpm76 [65, 86]Systolic BP mmHg122 (23)NTproBNP ng/L5875 [2208, 12761]Sodium, mmol/L138 [136, 141]Potassium, mmol/L4.2 [3.9,4.6]eGFR ml/min/1.73m*2On admission 54 [32,72]On discharge 51 [34,70]Hb g/L120 [108,138]Comorbidities5 [3,8]Rockwood score5 [3,6]Abbreviations: AF= Atrial Fibrillation, BP=blood pressure, bpm= beats per minute, NTproBNP= N-terminal pro-B-type natriuretic peptide, Hb= Haemoglobin