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Introduction Ambulatory heart failure (HF) care has undergone significant transformation within the Southern Health and Social Care Trust (SHSCT). However, there is no dedicated inpatient HF service. The 2024 National Heart Failure Audit (NHFA) report outlines recommendations on inpatient HF management including: echocardiogram, care under cardiology, Heart Failure Nurse Specialist (HFNS) and cardiac rehab input, and HF GRMT.Aim To establish a baseline of inpatient HF management in SHSCT compared to the NHFA recommendations.Methods This was a retrospective single centre study including patients discharged between September 2022-August 2023 with new HF or decompensated known HF. Electronic care records were reviewed assessing: discharging specialty, TTE, HF medications, follow-up post discharge, mortality and HF readmission at 1 year.Results 110 patients were included, 9% under Cardiology and 91% under General Medicine. 25% were new HF and 75% known decompensated HF. 57% of patients had an inpatient TTE compared to 90% advised by NHFA. 75% had a TTE within 1 year prior. Overall, 90% had a TTE either during admission or within the year prior. 1.8% patients were reviewed by HFNS during admission compared to the advised 100%. 53% of patients discharged alive were seen by HFNS with an average follow-up time of 77.5 days. NHFA recommends all patients be reviewed within 2 weeks. 8% of HFrEF patients were discharged on 4 pillar GRMT compared to the recommended 90%. 5% of patients were reviewed by cardiac rehabilitation compared to the recommended 100%. 10% of patients died during index admission and 34% died within 1 year of discharge. 30% of patients were readmitted with HF decompensation within 1 year.Conclusion This demonstrates that the lack of a dedicated inpatient HF service places patients at a substantial disadvantage. The introduction of an inpatient service has the potential to improve HF management and patient outcomes.Abstract 73 Figure 1Comparison of SHCT DGH inpatient HF management and follow up with NHFA recommendation