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Aims Accurate prevalence data for ambulatory advanced heart failure (HF) in European countries remains limited. This study was designed to identify the population of patients potentially eligible for referral for assessment for advanced surgical HF therapies to a National advanced HF and cardiac transplant centre. Methods and results A survey comprising 13 potential clinical markers of advanced HF was developed, modified from the ‘I NEED HELP’ tool from the 2018 position statement of the Heart Failure Association of the European Society of Cardiology, and distributed to all HF clinic services (secondary and tertiary units) nationwide. Each HF clinic unit was asked to complete the survey on consecutive patients over a 3 month period fulfilling the following three criteria: (i) age <65 years; (ii) ejection fraction <40% and (iii) HF of >3 months duration. As a comparison, the number of actual referrals to the advanced HF clinic were also audited over a 9 month period. In all, 21 of 26 HF clinic units participated in the survey. Across the period of inclusion, 4950 all‐comer HF patients were seen across all sites. Of these, 375 (7.5%) fulfilled the inclusion criteria and were surveyed (74.4% male, median age 57 years [IQR: 11 years]). In total, 246 (66%) of the surveyed patients had ≥1 potential markers for advanced HF, representing just under 5% of the total all‐comer HF population seen across the same time period. Of these, 67 patients (27%) had ≥2, 48 (20%) had 3 and 40 (16%) had ≥4 potential markers. The most frequently noted markers were ≥1 HF hospitalization or unscheduled clinic review (56%), intolerance to renin‐angiotensin‐aldosterone system inhibitors due to hypotension or renal dysfunction (29%) and intolerance to beta‐blockers due to hypotension (27%). Almost one‐quarter of patients reported NYHA Class III or IV symptoms. During the advanced HF clinic audit, the number of patients actually referred to the advanced HF clinic during the same time period was <5% of this potentially eligible cohort. Conclusions In this index prospective National survey, approximately 5% of an all‐comer routine HF clinic population and two‐thirds of a pre‐selected HF with reduced EF under 65 years cohort were found to have at least one clinical or biochemical marker suggesting advanced or impending advanced HF. Almost one‐quarter of patients in this chronic outpatient ‘snapshot’ population have NYHA III‐IV symptoms. This simple one‐page triage survey—modified from the ‘I NEED HELP’ tool—is useful to identify a population potentially eligible for referral to an advanced HF centre for assessment for advanced surgical therapies, thereby aiding resource and service planning.

Funding Acknowledgements Type of funding sources: None. Introduction The link between obstructive sleep apnoea (OSA) and cardiovascular disease is well known. Prevalence can be very high in this population, sharing many pathophysiological drivers in addition to being a risk factor. More concerning however is the increasing number of patients with undiagnosed OSA, who are at higher risk of long-term complications such as coronary artery disease, hypertension, atrial fibrillation, heart failure or stroke. There are several OSA screening tools available to clinicians, with variable sensitivities and specificities depending on patient demographics. Predictive efficacy of the STOP-Bang screening tool in a general cardiology population with mixed cardiovascular disease has not been established. Proposal To identify the correlation between the STOP-Bang assessment score (1-8) and real-world Apnoea-Hypopnoea Index (AHI) in a general cardiology clinic population. Methods 250 successive patients in a general cardiology clinic were asked to complete a STOP-Bang assessment. Of those, 50 patients with a variety of STOP-Bang scores were randomly selected to undergo sleep studies. A STOP-Bang value of ≥ 5 was taken as high-risk for moderate-severe OSA. Statistical linear regression analysis was performed in IBM SPSS version 26. Results Of n = 50 patients, mean STOP-Bang score =3.7 (SD +/-2.17) with mean AHI =15.8, (SD +/- 14.3). See Table 1 for categories 1-8. N = 44 (88%) had AHI ≥ 5 (At least mild OSA). N = 18 (36%) had an AHI ≥ 15 (Moderate-severe OSA). N = 29 (58%) had symptoms such as sleepiness, loud snoring or witnessed apnoea. Correlation between STOP-Bang score and AHI was high, with an  R value of 0.704, R2 = 0.496 (p &lt; 0.01). A STOP-Bang score increase of 1 corresponded with a mean AHI rise of 4.648. When taking a STOP-Bang value of ≥ 5 as "positive", we demonstrated a sensitivity of 83.33% (95% C.I. 58.58-96.42) and specificity of 93.94% (95% C.I. 79.77-99.26%) for moderate-severe OSA (AHI ≥ 15).  Conclusion We discovered a very high number of patients with undiagnosed OSA of at least mild severity. We found a strong correlation between STOP-Bang score and real-world AHI in a general cardiology population with mixed cardiovascular disease with 5 as an acceptable screening score for moderate-severe OSA. Table 1 STOP-Bang Value 1 2 3 4 5 6 7 8 Patients (N=) 12 5 7 9 5 5 5 2 AHI (Mean) 6.67 6.62 9.97 11.95 24.44 22.20 39.54 35.25 Standard Deviation (±) 3.29 2.74 3.45 4.63 12.87 5.69 27.2 6.72 Summary of mean apnoea-hypopnoea index and standard deviation for each STOP-Bang patient category. Abstract Figure 1

since first implant (Median duration 15.7 ± 8.3 months). There were no cases of device migration or failure. Mean R wave sensing was 13.7 ± 5.8 mV. 16 of the 18 patients had a threshold £ 1V. Two patients were noted to have higher thresholds (2.88 mV and 3.25 mV). (Table 2). Conclusion In our patient cohort, use of Micra™ transcatheter pacemaker insertion was a safe alternative to conventional pacemaker insertion. The minimally invasive implantation was associated with a low acute complication rate and acceptable pacing parameters at follow-up. Longer term follow-up is ongoing.

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