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Background The evaluation of clinical status in Heart Failure (HF) is challenging and often limited by the indistinct nature of symptoms and lack of sensitivity of clinical examination. Natriuretic Peptide (NP) has been shown to be a reliable overall determinant of prognosis in HF, but it is unclear if repeated NP analysis in the clinically stable setting can enhance our capacity to define stability.Aim To assess variations in NP in patients with clinically stable HF to determine whether they indicate any significant risk in the subsequent clinical course.Methods This is an interim analysis of an ongoing single-centre, prospective observational study, including all patients who completed annual review between August 2023- April 2025 and were deemed stable in the preceding year defined as;No HF hospitalisationsNo outpatient episodes of clinical deteriorationNo increase in oral diuretic therapy.The degree of change in NP is categorised as ; 30% increase, stable or 30% decrease. These changes are correlated to their clinical course over the subsequent 6 and 12 months to ascertain whether they indicate any risk in the subsequent immediate clinical course.Results 494 patients are included in this ongoing study and 323 patients have achieved a 6 month outcome ( table 1). 83/323 patients (27%) had ≥ 30% increase in NP, with the remaining 73% showing a stable value or ≥ 30% downtrend. When correlated to their clinical course subsequently, a <1% rate of HF decompensation is observed across all degrees of variation in NP (figure 1).Conclusion A clinically significant increase in NP does occur in a sizable minority of stable HF patients. However, there is no evidence to support that in the absence of HF symptoms or signs, this denotes a significant additional risk of intermediate term HF events in clinically stable HF.Abstract 18 Figure 16 and 12 month outcomes based on the degree of variation in naturetic peptide in stable heart failureAbstract 18 Table 1Selected baseline characteristics of patients. Values are reported as Mean (S.D) or n (%) as appropriate Abbreviations: HFpEF: Heart Failure preserved ejection fraction HFFEF: Heart Failure reduced ejection fraction COPD: Chronic obstructive pulmonary disease NT-proBNP TO: NT-proBNP at least 12 months prior to annual assessment NT-proBNP T1: NT-proBNP during annual assessment