Nottingham University Hospitals NHS Trust Research Articles

Diagnostic accuracy of autofluorescence-Raman microspectroscopy for surgical margin assessment during Mohs micrographic surgery of basal cell carcinoma.

Autofluorescence (AF)-Raman microspectroscopy is a technology that can detect residual basal cell carcinoma (BCC) on the resection margin of fresh, surgically excised tissue specimens. The technology does not require tissue fixation, staining, labelling or sectioning, and provides quantitative diagnosis maps of the surgical margins in 30 min. To determine the accuracy of the AF-Raman instrument in detecting incomplete BCC excisions during Mohs micrographic surgery (MMS), using histology as the reference standard. Skin layers from 130 patients undergoing MMS at the Nottingham University Hospitals NHS Trust (September 2022-July 2023) were investigated with the AF-Raman instrument. The layers were measured when fresh, immediately after excision. The AF-Raman results and the intraoperative assessment by Mohs surgeons were compared with a postoperative consensus-derived reference produced by three dermatopathologists. The sensitivity, specificity, and positive and negative predictive values were calculated. The study was registered with ClinicalTrials.gov (NCT03482622). AF-Raman analysis was successfully completed for 125 of 130 layers and, on average, covered 91% of the specimen surface area, with the lowest surface area covered being 87% for the eyelid and the highest being 94% for forehead specimens. The AF-Raman instrument identified positive margins in 24 of 36 BCC-positive cases [67% sensitivity, 95% confidence interval (CI) 49-82] and negative margins in 65 of 89 BCC-negative cases (73% specificity, 95% CI 63-82). Only one of 12 false-negative cases was caused by misclassification by the AF-Raman algorithm. The other 11 false-negatives cases were a result of no valid Raman signal being recorded at the location of the residual BCC due to either occlusion by blood or poor contact between tissue and the cassette window. The intraoperative diagnosis by Mohs surgeons identified positive margins in 31 of 36 BCC-positive cases (86% sensitivity, 95% CI 70-95) and negative margins in 79 of 89 BCC-negative cases (89% specificity, 95% CI 81-95). The AF-Raman instrument has the potential to provide intraoperative microscopic assessment of surgical margins in BCC surgery. Further improvements are required for tissue processing, to ensure complete coverage of the surgical specimens.

Long‐Term Outcomes in Patients with ST‐Elevation Myocardial Infarction: A Comparative Study of Direct Admissions versus Interhospital Transfers—Insights from a Single‐Center Experience in the United Kingdom

Background. Primary percutaneous coronary intervention (PPCI) is the treatment of choice for patients with ST‐elevation myocardial infarction (STEMI). Delayed reperfusion leads to increased morbidity and mortality. Secular trends in the impact of interhospital transfers (IT) on long‐term mortality in the United Kingdom (UK) have not been previously investigated. We analyzed the impact of IT on 5‐year mortality in STEMI patients admitted to a tertiary care center in the UK (East Midlands North). Methods. Data of STEMI patients admitted to Nottingham University Hospitals NHS Trust from 2011 to 2016 were acquired from the National Institute for Cardiovascular Outcomes Research dataset (NICOR) and then combined with local patient‐level data and mortality data from National Statistics. The baseline characteristics and mortality data of the interhospital transfer (IT) group were compared to those of a gender and age‐matched direct admission (DA) group. Results. Of the total cohort (N = 2386), 29.9% of patients were admitted to the PPCI center via the interhospital transfer (IT) route. Cardiovascular risk profiles in both DA and IT groups were comparable. Five‐year Kaplan–Meier (KM) survival analysis revealed better survival in the direct admission group (83% vs. 77.3%; p ≤ 0.001). In multivariate analysis, increased mortality was associated with severe left ventricular impairment (HR 4.7, 95% CI 2.9–7.6), the presence of cardiogenic shock (HR 3.6 (2.7–4.8)), chronic kidney disease (HR 2.56 (1.4–4.5)), smoking (HR 1.45 (1.1–1.8)), male gender (HR 1.7 (1.4–2.01)), and diabetes (HR 1.4 (1.07–1.8)). The radial access and call‐to‐balloon time less than 120 minutes were also associated with lower mortality (HR 0.52 (0.43–0.63): HR 0.75 (0.61–0.92)). Conclusion. Despite advancements in communication, technology, patient education, transportation systems, and guidelines within the UK’s NHS over the last decade, the delays incurred by IT for STEMI patients remain substantial and are associated with a poor prognosis.

British Nuclear Medicine Society Clinical Guidelines for Gastric empty.

aDepartment of Physics and Nuclear Medicine, Consultant Physician in Nuclear Medicine, Sandwell and West Birmingham NHS Trust, Birmingham bHead of Nuclear Medicine Physics, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire cMedical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK Received 14 December 2022 Accepted 28 March 2023. Correspondence to Alp Notghi, Department of Physics and Nuclear Medicine, Consultant Physician in Nuclear Medicine, Sandwell and West Birmingham NHS Trust, City Hospital, Dudley Road, Birmingham B18 7QH, UK, E-mail: [email protected]

Donna Ockenden: dedicated to improving UK maternity services

Donna Ockenden is a respected UK health-services leader. A Welsh native and nurse and midwife by training, she is Chair of the Independent Review of Maternity Services at the Nottingham University Hospitals NHS Trust, UK. Speaking about her priorities in the role, the straight-talking Ockenden says: “I’m absolutely clear that all voices that want to be heard, will be heard, and will be amplified. And what they tell us absolutely will be acted upon. We know that Nottingham has a diverse population and a community and from day one we are ensuring that we listen to and act upon the voices of all those women and families.” Noting that families campaigned for the review after the deaths of babies, she adds that “we need to make sure that families get the answers that they deserve, but also that they can see meaningful and sustainable change in the safety and quality of maternity services for their local communities…We will work with the trust to ensure that change happens in a timely way.”

O082 A pilot study on prehabilitation for patients undergoing surgery for cancer

Abstract Introduction In 2022 Nottingham University Hospital NHS Trust (NUH) began offering structured prehabilitation sessions for patients diagnosed with cancer, to help them better prepare for surgical treatment. We have undertaken an audit of patients enrolled onto the programme and examined key outcomes. Methods Patients requiring surgery for cancer were initially assessed (April – Oct 2022) and offered 2-3 prehabilitation sessions per week. During initial and final Prehabilitation assessments, patients completed a sit-stand test, shuttle walk test and Patient Reported Outcome Measures for anxiety (GAD-7) and depression (PHQ-9). Results Two hundred and twelve patients were enrolled onto the prehabilitation programme and 87 (41%) completed the pre- and post-assessment after 3-6 weeks. Colorectal (47, 54%) and gynaecological (17, 22%) surgery represented the two major procedures for those completing the programme. Mean (±sem) physical activity score (140.1±19.4, n=78) was significantly increased (p<0.001) at the end of the programme (315.3±23.8). Mean shuttle walk test score (340.2±28.7, n=54) increased by approximately 15% (p<0.001) at the end of the programme (394±32.8), while the sit-stand test (24.9±1.3, n=64) also improved significantly (30.9±1.5; p<0.001). The mean (±sem) anxiety GAD-7 score (6.06±0.64 n=85) and depression PHQ-9 score (5.38±0.69, n=85) were significantly reduced (p<0.001) by the programme (3.29±0.46 and 2.76±0.45, respectively). Conclusion Initial results from the NUH prehabilitation programme provide evidence for a significant increase in physical activity prior to surgery, accompanied by a general improvement in the mental well-being of the patients.

P073 Comparative effectiveness of different exercise interventions on central sensitisation indices in humans: A systematic review and network meta-analysis

Abstract Background/Aims Exercise has shown a promising effect in reducing central sensitisation (CS), but it is unknown which exercise type is the most effective. This review aimed to rank and compare the effectiveness of different exercise interventions on CS in people with or without chronic musculoskeletal pain. This will help to identify the optimal exercise intervention to improve pain by reducing CS for subsequent use in clinical trials. Methods We searched MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus, CENTRAL, PEdro, SCOPUS, as well as references cited in the selected papers, and grey literature from inception to February 2022. We included randomized controlled trials (RCTs) that assessed the effect of exercise interventions on CS indices in humans. RCTs where a specific effect of exercise could not be determined were excluded. Pairwise and network meta-analyses (frequentist and Bayesian) were conducted using random effects models. Effect sizes were calculated using standardized mean difference (SMD). P-score as well as SUCRA score were used to rank the exercise interventions (from best to worst) in both frequentist and Bayesian approaches, respectively. Results The search returned 93,657 records, of which 143 RCTs (5,362 participants [4890 participants had musculoskeletal pain (122 studies), and 427 were pain free (21 studies)]) were eligible. Firstly, we performed the pairwise meta-analysis to examine the effect of all exercise interventions on all CS outcomes. It showed moderate improvement of CS outcomes (SMD - 0.77, 95% confidence interval (95%CI) -0.89 to -0.65, I2 = 87%, p < 0.01). After that, 80 RCTs were included in the network meta-analysis (NMA) using inactive controls as a common comparator. In terms of efficacy at improving indices of CS, all exercise interventions were more effective than control. Combined strengthening and stretching exercise exhibited the highest probability to be the optimal intervention reducing CS (P-score: 0.8896, SUCRA score: 0.8719, SMD= -2.02, 95%CI: -2.83: -1.20), followed by strengthening, stretching and aerobic combination (P-score: 0.8557, SUCRA score: 0.8517, SMD = -1.92, 95%CI: -2.90: -0.95), and stretching with aerobic exercise (P-score: 0.7794, SUCRA score: 0.7198, SMD = -1.70, 95%CI: -2.79: -0.62). However, differences between these three interventions’ effect sizes were small, and 95% CI were overlapping. Other interventions included, mind body exercise, aerobic plus strengthening exercise, strengthening exercise, stretching exercise, aerobic exercise. Conclusion Our meta-analysis suggested that various exercise interventions are effective in improving CS. Multicomponent exercise tends to be the most effective, but some exercise combinations might be better than others. Strengthening and stretching combination shows the greatest likelihood among other combinations of being the optimal exercise type. These findings might have utility informing future treatment recommendations for people with CS features. However, Further research should be considered to explore cost-effectiveness of different interventions. Disclosure A.A. Abd Elkhabir: None. D.F. McWilliams: Grants/research support; grant support from Pfizer and Eli Lilly. S. Smith: None. W. Chaplin: None. M. Salimian: None. V. Georgopoulos: None. A. Kouraki: None. D.A. Walsh: Consultancies; Since 2015 DAW has undertaken consultancy through the University of Nottingham to AbbVie Ltd, Pfizer Ltd, Eli Lilly and Company, Love Productions,, Reckitt Benckiser Health Limited and GSK (each non-personal, pecuniary). Honoraria; He has contributed to educational materials through the University of Nottingham, supported by Medscape Education, New York,, International Association for the Study of Pain, and Osteoarthritis Research Society International (OARSI), each of which received financial support from commercial and non-commercial entities, (each non-personal, pecuniary).. Member of speakers’ bureau; He has received speaker fees from the Irish Society for Rheumatology (personal pecuniary).. Grants/research support; He has been responsible for research funded by Pfizer, Eli Lilly, UCB Pharma (non-personal, pecuniary). Other; He receives salary from the University of Nottingham, who have received funding for that purpose from Sherwood Forest Hospitals NHS Foundation Trust,, Nottingham University Hospitals NHS Trust and UKRI/Versus Arthritis (personal, pecuniary).

Reasons for optimism in respiratory infections

Nottingham University Hospitals NHS Trust, University of Nottingham, Respiratory Medicine Department, Nottingham, UK Correspondence to Wei Shen Lim, Consultant Respiratory Physician & Honorary Professor of Respiratory Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Respiratory Medicine Department, Nottingham NG5 1PB, UK. E-mail: [email protected]

Editorial introductions.

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned to a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Matteo BassettiMatteo BassettiMatteo Bassetti is Head of the Infectious Diseases Clinic of the Policlinico San Martino University Hospital in Genoa and Full Professor of Infectious Diseases of the University of Genoa, Italy. Dr Bassetti studied at the University of Genoa School of Medicine and continued his medical education at the Yale University School of Medicine, New Haven, USA with an Infectious Diseases fellowship. Dr Bassetti is Chair of the Critically Ill Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), president of the Italian Society of Anti-infective Therapy (SITA) and member of executive committee for the battle against antimicrobial resistance of the Italian Minister of Health (PNCAR). He is member-elected (2018-2022) of International Council of the Immunocompromised Host Society (ICHS). From 2019, he is member of the council of International Sepsis Forum (ISF). He serves on the editorial board of several prestigious international journals. He is author or co-author of 750 papers (H index 85; 30000 citations) published in International peer-review journals and several chapter's book on antibiotic therapy, fungal infections, antimicrobial resistances, infections in immunocompromised patients and critically ill patients. Wei Shen LimWei Shen LimProfessor Wei Shen Lim is consultant respiratory physician at Nottingham University Hospitals NHS Trust and Honorary Professor of Respiratory Medicine, University of Nottingham, UK. He is Chair of COVID-19 Immunisation on the Joint Committee of Vaccination and Immunisation (JCVI), UK and a member of various national advisory groups including the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) to the Chief Medical Officer for England. He was Chief Investigator of the hibernated ASAP Trial of Dexamethasone in Pandemic Influenza (2012-2022), and co-led the evaluation of Dexamethasone for COVID-19 in the RECOVERY TRIAL He has been involved with the British Thoracic Society (BTS) and the National Institute for Health and Care Excellence (NICE) in the development of various national clinical management guidelines for acute respiratory infections including community acquired pneumonia, pandemic influenza and COVID-19. He developed the CURB-65 severity assessment score for community acquired pneumonia and the BTS community acquired pneumonia care bundle. He was awarded the British Thoracic Society Meritorious Award in 2016 for contributions towards respiratory infections, and in 2021 the Moxon Medal by the Royal College of Physicians (London).

The Nottingham Ischaemic Cardiovascular Magnetic Resonance resource (NotIs CMR): a prospective paired clinical and imaging scar database—protocol

IntroductionResearch utilising artificial intelligence (AI) and cardiovascular magnetic resonance (CMR) is rapidly evolving with various objectives, however AI model development, generalisation and performance may be hindered by availability of robust training datasets including contrast enhanced images. MethodsNotIs CMR is a large UK, prospective, multicentre, observational cohort study to guide the development of a biventricular AI scar model. Patients with ischaemic heart disease undergoing clinically indicated contrast-enhanced cardiac magnetic resonance imaging will be recruited at Nottingham University Hospitals NHS Trust and Mid-Yorkshire Hospital NHS Trust. Baseline assessment will include cardiac magnetic resonance imaging, demographic data, medical history, electrocardiographic and serum biomarkers. Participants will undergo monitoring for a minimum of 5 years to document any major cardiovascular adverse events. The main objectives include (1) AI training, validation and testing to improve the performance, applicability and adaptability of an AI biventricular scar segmentation model being developed by the authors and (2) develop a curated, disease-specific imaging database to support future research and collaborations and, (3) to explore associations in clinical outcome for future risk prediction modelling studies. ConclusionNotIs CMR will collect and curate disease-specific, paired imaging and clinical datasets to develop an AI biventricular scar model whilst providing a database to support future research and collaboration in Artificial Intelligence and ischaemic heart disease.

Evaluation oncotype DX® 21-gene recurrence score andclinicopathological parameters: a single institutional experience.

Oncotype DX recurrence score (RS) is a clinically validated assay, which predicts the likelihood of disease recurrence in oestrogen receptor-positive/HER2-negative (ER+/HER2-) breast cancer (BC). In this study we aimed to compare the performance of Oncotype DX against the conventional clinicopathological parameters using a large BC cohort diagnosed in a single institution. A cohort (n= 430) of ER+/HER2- BC patients who were diagnosed at the Nottingham University Hospitals NHS Trust and had Oncotype DX testing was included. Correlation with the clinicopathological and other biomarkers, including the proliferation index, was analysed. The median Oncotype DX RS was 17.5 (range=0-69). There was a significant association between high RS and grade 3 tumours. No grade 1BC or grade 2 tumours with mitosis score 1 showed high RS. Low RS was significantly associated with special tumour types where none of the patients with classical lobular or tubular carcinomas had a high RS. There was an inverse association between RS and levels of ER and progesterone receptor (PR) expression and a positive linear correlation with Ki67 labelling index. Notably, six patients who developed recurrence had an intermediate RS; however, four of these six cases (67%) were identified as high-risk disease when the conventional clinical and molecular parameters were considered. Oncotype DX RS is correlated strongly with the conventional clinicopathological parameters in BC. Some tumour features such as tumour grade, type, PR status and Ki67 index can be used as surrogate markers in certain scenarios.

PP558 [Post PICU » Post intensive care syndrome (PICS)]: A NEW STATISTICAL METHODOLOGY TO INVESTIGATE POST INTENSIVE CARE SYNDROME IN PEDIATRIC SURVIVORS AND THEIR FAMILIES

1Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland 2Nottingham Children’s Hospital and Neonatology, Nottingham University Hospitals NHS Trust School of Health Sciences, University of Nottingham, UK 3Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland

The Acute VertEbRal AugmentaTion (AVERT) study: protocol for a randomised controlled, feasibility trial of spinal medial branch nerve block in hospitalised older patients with vertebral fragility fractures

IntroductionVertebral fragility fractures (VFFs) are the most common type of osteoporotic fracture found in older people, resulting in increasing morbidity and excess mortality. These fractures can cause significant pain, requiring...

18 - Difficulty meeting RCR consensus criteria provides valuable opportunity to review and improve the lung cancer pathway at Nottingham University Hospitals NHS Trust

18 - Difficulty meeting RCR consensus criteria provides valuable opportunity to review and improve the lung cancer pathway at Nottingham University Hospitals NHS Trust

NHS trust to trial smoking cessation referrals from maternity services to community pharmacy

Patients accessing maternity services at Nottingham University Hospitals NHS Trust could be offered smoking cessation treatment at a community pharmacy under a new NHS pilot. The scheme builds on the ‘NHS community pharmacy smoking cessation advanced service‘ — which rolled out nationally in England on 10 March 2022 — through which hospitals can refer patients […]

Continuing professional development in children's nursing: identifying needs and delivering quality assured activities.

Continuing professional development (CPD) for nurses is intrinsically linked to quality improvement, improved patient safety and outcomes, career progression, and recruitment and retention, as well as being integral to nurses' lifelong development. However, despite these advantages, there is no framework to develop, accredit, deliver and measure the outcomes of CPD in the UK. This article outlines the elements of a CPD framework for excellence for children's nurses that was developed by the lead for excellence in nursing practice at Nottingham Children's Hospital, England, in collaboration with lead educators and facilitators of CPD activities. To develop the framework, they scoped existing CPD activities and mapped the content to a quality standards framework. Each of the 39 CPD activities identified were then submitted to the Nottingham University Hospitals NHS Trust Institute of Care Excellence for accreditation, with the aim of providing quality assurance. The framework for excellence aims to support the delivery of credentialed high-quality, evidence-based information that meets the needs of children's nurses, with the future capability to measure learning outcomes.

Mosunetuzumab in Combination with Lenalidomide Has a Manageable Safety Profile and Encouraging Activity in Patients with Relapsed/Refractory Follicular Lymphoma: Initial Results from a Phase Ib Study

Mosunetuzumab in Combination with Lenalidomide Has a Manageable Safety Profile and Encouraging Activity in Patients with Relapsed/Refractory Follicular Lymphoma: Initial Results from a Phase Ib Study

There is still time to save the NHS, but time is running out

The NHS is falling over. Not everywhere, but in some places and in some services the signs of extreme stress are manifest. These signs are the result of the irresistible...

Estimating the clinical prevalence of Wilson’s disease in the UK

Background & AimsThe clinical prevalence of Wilson’s disease (WD) in the UK remains unknown. The estimated genetic prevalence in the UK, 142/million, is higher than the clinical prevalence (15/million) reported in other European studies. The aim of this study was to estimate the clinical prevalence of WD utilising readily available laboratory and clinical data.MethodPatients with WD who attended Nottingham University Hospital NHS Trust (NUH) between 2011 and 2018 were identified using multiple sources of case ascertainment: serum ceruloplasmin, 24-hour urinary copper, ‘Wilson’ in liver biopsy report, hospital prescription for penicillamine/trientine/zinc and admission coded with ICD-10 Code E83.0 (disorder of copper metabolism). Potential cases were identified using the Leipzig score, diagnosis was confirmed in hospital records and the point prevalence was calculated using the Office for National Statistics mid-2017 population estimates.ResultsA total of 1,794 patients were identified from ≥1 source; 19 patients had WD, of whom 11 were from within the study catchment area and alive at the time of point prevalence estimation. Twenty-nine patients had a Leipzig score ≥2 without a diagnosis of WD, but none had WD on screening (n = 16). The overall prevalence of WD was 15.5/million; males 16.9/million and females 14.1/million.ConclusionThis is the first UK population-based study to assess the clinical prevalence of WD. The reported clinical prevalence is lower than the UK genetic prevalence, but comparable to the clinical prevalence reported in Europe. The case ascertainment approach used in this study may be cost-effective, and similar practises could be adopted nationally.Lay summaryOur study estimates the clinical prevalence of Wilson’s disease, a rare genetic disorder of copper metabolism, in the UK. The estimated clinical prevalence is this study is markedly lower than the estimated UK genetic prevalence.

520 AN EVALUATION OF VIRTUAL MUSIC THERAPY TO PATIENTS ON AN ACUTE HEALTH CARE OF OLDER PEOPLE WARD DURING THE COVID-19 PANDEMIC

IntroductionMusic therapy has been shown to reduce anxiety and social isolation for elderly patients in the acute hospital setting. At Nottingham University Hospital NHS Trust a programme of live, face-to-face music has been delivered by Wellspring Music on Healthcare of Older Peoples wards since 2015. In response to COVID-19, face-to-face delivery was stopped and a virtual method was proposed. This project investigated feasibility of virtual live music delivery.MethodTwelve, two-hour music therapy sessions were delivered by Wellspring Music to 41 patients over six weeks. The validated Arts-obs tool was used by staff members facilitating the sessions to record observations of patient mood, relaxation, and distraction from the ward setting on Likert scales. Patient, ward staff, and facilitator feedback were also recorded. Qualitative and quantitative analyses were conducted by an Occupational Therapist.ResultsData from the Arts-obs tool showed that thirty-two patients had an observable improvement in mood, seven had no mood change, and two presented a slightly worsened mood. Fourteen patients were fully engaged with the music therapy, sixteen were partially engaged, and eleven were focussed on the hospital environment. Thirty-four patients were visibly more relaxed, and seven showed no change. Patient feedback ranged from gratitude and expressions of enjoyment of the session to finding it too loud. Ward staff feedback ranged from appreciation to finding the music too distracting. The Wellspring musician and staff facilitators reported occasional loss of internet connection, and patients sometimes focusing on the facilitator rather than the musician.ConclusionIt is feasible to deliver virtual music therapy to inpatients on Health Care of Older People wards. Feedback shows that this was largely acceptable to staff and patients. Improvements in mood, relaxation and distraction were found.

Real-world outcomes from the systemic use of CDK 4/6 inhibitors (CDKIs) in the management of ER positive (+) HER2 negative (-) metastatic breast cancer (mBC).

e13031 Background: The use of CDKIs have transformed the management of ER+HER2- mBC. As the real-world data matures, this project describes patterns in response to systemic therapy that may inform treatment planning and prognostication. Methods: We analysed the ER+HER2- mBC dataset at Nottingham University Hospitals NHS Trust (NUH) generated by reviewing clinical notes, radiology and e-prescribing records to collect clinical data on patients treated with CDKIs between 01/10/2016 - 01/10/2020. Results: 272 patients with a median age of 65 years (30-90 years) were treated with CDKIs (palbociclib 54.0% (n=147); ribociclib 19.5% (n=53); abemaciclib 26.5% (n=72)) in combination with endocrine therapies (letrozole, anastrozole, exemestane and, fulvestrant). Median overall survival was 49.5 months. Treatment with first-line CDKIs (69.8%; n=190) resulted in superior PFS when compared to CDKIs in a ≥ second-line setting (30.2%; n=82) i.e., mPFS 21.3 vs 12.2 months (HR 0.67; 95% CI, 0.47-0.96; P=0.02). Univariate analysis shown in the table below indicates the benefit to PFS from presentations with de novo mBC and the absence of visceral metastases. In patients treated curatively for early breast cancer (EBC), better outcomes were demonstrated in patients presenting with mBC, >12 months versus ≤12 months of completion of adjuvant endocrine therapy i.e., mPFS 28.4 vs 12.1 months (HR 0.50; 95% CI, 0.30-0.84; P=0.004) when treated with first-line CDKIs. A multivariate analysis identified benefit to PFS from first-line therapy with CDKIs (HR 0.70; 95% CI, 0.49-1.01; P=0.05) and presentation with de novo mBC (HR 0.56; 95% CI, 0.37-0.85; P=0.006). The presence of visceral metastases was associated with poorer outcomes (HR 1.52; 95% CI, 1.08-2.15; P=0.01). Conclusions: This analysis confirms the PFS benefit from CDKIs demonstrated in clinical trials is mirrored in the real-world setting. The analysis was not powered to delineate survival benefit between the individual CDKIs. Presentations with mBC following a prior history of EBC, within ≤12 months of completion of adjuvant endocrine therapy, and with visceral metastases may help predict poorer clinical outcomes and may need to be considered when prognosticating and in treatment planning. This analysis is hypotheses-generating and we will confirm our findings in a prospective manner as the dataset is expanded.[Table: see text]