Background <p>Up to 50% of patients with heart failure (HF) have co-morbid atrial fibrillation (AF).¹ Trialling rhythm control has been recommended for AF with reduced left ventricular ejection fraction (LVEF) as restoring sinus rhythm can improve LVEF in select patients. ^{2, 3}</p> Aims <p> To audit of our AF management strategies among patients with co-morbid HF.</p> Methods <p> A retrospective observational study of patients attending our Heart Efficiency Clinic (HEC) with HF and AF reviewing if any rhythm control measure was attempted over the prior three years.</p> Results <p> Between 1^st to 31^st January 2025, 56% (n=49) of the 88 patients with HF who attended the HEC had AF. The mean age of those with HF and AF was 77.5 years (IQR 69.5-87.5), 67.3% (n=33) of whom had index LVEF &lt;50%. Rhythm control was attempted in 41% (n=20) of cases over the prior three years [DCCV 32.7% (n=16); ablation referral 8.2% (n=4), antiarrhythmic prescribed 20.4% (n=10)]. Compared to those with LVEF ≥50%, those with LVEF &lt;50% were more likely to be offered DCCV [OR: 5.158 (95% CI 1.006-26.445)], or any rhythm control [OR: 8.400 (95% CI 1.642-42.974)]. Attempting rhythm control was also associated with lower age and absence of known coronary artery disease, but not sex, left atrial diameter, NYHA Classification, eGFR or valve disease.</p> Conclusions <p> In keeping with guidelines, our HEC is more likely to trial AF rhythm control for those with reduced LV function as well as younger patients. We aim to expand our ablation referrals as access has increased.</p>