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Introduction Heart failure (HF) is associated with high mortality and morbidity, worsened by delay in diagnosis and therapy initiation. NICE have recommended that patients with a BNP>2000 and those with a BNP 400-2000, should be reviewed by a HF specialist within two and six weeks respectively. The Southern Health and Social Care Trust (SHSCT) has undertaken steps to reconfigure its HF service with nominal increase in resources. The previous model, the consultant-led Rapid Access Heart Failure Clinic (RAHFC) where all patients had an echocardiogram on the day of clinic review, originally saw a vast improvement in waiting times. However, this was soon overwhelmed by system demand. Through reallocation of resources and reconfiguration of existing clinical pathways, the SHSCT aimed to develop a more efficient diagnostic HF pathway.Aim This was a targeted review of the new DTT HF pathway, comparing the waiting time for review of new diagnosis of HF to the previous RAHFC pathway.Methods In March 2025, the new Direct to Test (DTT) system was implemented, wherein all new suspected HF patients were triaged directly to echocardiography. Results were then triaged with all new patients with Ejection Fraction (EF) ≤40% reviewed in the multidisciplinary Acute Cardiology Unit (ACU), and other pathology redirected to general cardiology clinic ( figure 1).Following this reconfiguration, waiting times for patients who attended ACU with a new diagnosis of HF from April 2025 to September 2025 were reviewed. These were compared with data collected from patients who attended the RAHFC from November 2022 to May 2023.Results Through the new DTT pathway, 110 patients with left sided HF were reviewed. The average BNP was 1985pg/ml. The average time from referral to appointment was 18.9 days and median time 15.5 days. Of those with a BNP at time of referral (n=85), 59 (69.4%) met the NICE recommendations.This is a considerable improvement from the previous RAHFC pathway. Within the time period reviewed, 205 patients attended the consultant-led clinic, with 159 (77%) diagnosed with left-sided HF following same day echocardiography and review. The average BNP was 2449pg/ml. The average time from referral to appointment was 100.3 days and median time 66 days. Of this cohort, 51 (25%) patients were reviewed within the NICE recommended timeframe.Conclusion The new diagnostic HF pathway has demonstrated a dramatic reduction in waiting times for newly suspected HF patients. The prioritisation of patients with an EF≤40% allows allocation of resources aimed at the most benefit. This streamlining the patients’ healthcare journey facilitates the rapid diagnosis and initiation of HF therapies, with the potential positive impact on patients’ quality of life and prognosis. Through ongoing service mapping via the HF Strategic Leadership Group, this pathway may exemplify a future, standardized regional model, aimed at optimising efficiency and health equity for all HF patients.Abstract 553 Figure 1Illustration of HF diagnostic pathwayAbstract 553 Figure 2Comparison of average and median waiting times to first appointment for the respective HF diagnostic pathway models