<h3>Background/Introduction</h3> Acute decompensated heart failure (ADHF) leads to hospitalisations, frequent re-hospitalisations and mortality. The safety and efficacy of telehealth-guided outpatient ADHF management (virtual ward-VW) as an alternative to hospitalisation has not been assessed previously. <h3>Aim</h3> The aim of this study was to assess the safety and outcomes of our acute heart failure virtual ward (HFVW) pathway (figure 1) when compared to hospitalised ADHF patients. <h3>Methods</h3> This cohort study (May 2022-October 2023) assessed the outcomes of telehealth-guided outpatient ADHF management using bolus intravenous furosemide in a HF-specialist VW. We compared baseline patient characteristics, NTproBNP, ejection fraction, NYHA Class, clinical risk score (Get With the Guidelines-Heart Failure-GWTG-HF), comorbidities (Charlson Co-morbidity Index-CCI), frailty (Rockwood Clinical Frailty Score-CFS), HF therapies and measured clinical outcomes at 1, 3, 6 and 12 months (re-hospitalisations, mortality) in the HFVW cohort versus standard care (ADHF patients managed without telehealth in 2021). <h3>Results</h3> 554 HFVW ADHF patients (age 73.1±10.9 years; 46% female) were compared with 402 ADHF patients (74.2±11.8; p=0.15 and 49% female) in the standard care cohort (SC). Despite similar baseline patient characteristics, GWTG-HF score, CCI and CFS, re-hospitalisations were significantly lower in the HFVW compared to standard care (1 month - 11.6% vs. 21%, p=0.002; 3 months - 20.4% vs. 30%, p=0.001; 6 months -29.3% vs 41%, p=0.02 and 12 months-48% vs. 57%,p=0.03) whereas mortality was lower at 1 month (6% vs. 14%; p&lt;0.001), 3 months (10.5% vs. 15%; p=0.02) and 6 months (15.5% vs. 21%; p=0.04) (figure 2). Multivariate logistic regression analysis showed that an increased daily step count whilst on HFVW independently predicted reduced odds of re-hospitalisations at 1 month (OR 0.85; 95% CI 0.7–0.9; p=0.005), 3 months [OR 0.95 (0.93–0.98); p=0.003] and 1 month mortality [OR 0.85 (0.7–0.95), p=0.01]. Whereas CCI predicted adverse 12-month outcomes [OR 1.2 (1.1–1.4), p=0.03]. Higher GWTG-HF score independently predicted increased odds of re-hospitalisation [1-month OR 1.2 (1.1–1.3), p=0.01; 12-month OR 1.1, 1.05–1.2, p=0.03) as well as mortality [1-month OR 1.2 (1.1–1.4), p=0.01; 12-month OR 1.3 (1.1–1.7), p=0.02]. Similarly higher CFS also independently predicted increased odds of re-hospitalisations [1-month OR 1.5 (1.1–2.2), p=0.03; 12-month OR 1.9 (1.2–3, p=0.01] and mortality [1-month OR 2 (1.1–3.5), p=0.02; 12-month OR 2.6 (1.6–10); p=0.02] throughout the follow-up period. <h3>Conclusions</h3> A telehealth-guided specialist HFVW management strategy for ADHF may offer a safe and efficacious alternative to hospitalisation in suitable patients. Daily step count, GWTG, CCI and CFS can play a vital role in assessing suitability for VW and in predicting risk of adverse clinical outcomes. <h3>Conflict of Interest</h3> None

139 Telehealth-aided outpatient management of acute heart failure in a specialist virtual ward compared to standard care