BACKGROUND: Hospitalisation with acute heart failure (AHF) carries a high risk of death, and those surviving to discharge remain at high risk of death or rehospitalisation with AHF. The impact of outpatient heart failure (HF) specialist care after discharge from AHF hospitalisation on longer-term outcomes is unclear in contemporary UK practice. METHODS: A retrospective analysis of a cohort of 2104 patients admitted to hospital due to AHF between 2014-2022 in a single UK county was performed. Patient characteristics, left ventricular ejection fraction (EF) (LVEF) category (HF with reduced EF (LVEF ≤40%; HFrEF), HF with mildy reduced EF (LVEF 41%-49%; HFmrEF) and HF with preserved EF (LVEF ≥50%; HFpEF)) and survival free from a composite end point of AHF rehospitalisation or death are described. Cox regression survival analysis was performed to explore the impact of baseline patient characteristics and HF specialist care on long-term outcomes. RESULTS: The median age of the cohort was 83 years. HFrEF was present in 36%, HFmrEF in 9% and HFpEF in 55%. 13% died during index AHF hospitalisation. Median follow-up for those surviving to discharge was 618 (IQR 264-1275) days. 21% were rehospitalised due to AHF, and 63% died during follow-up. On adjusted survival analysis of 1511 patients with echocardiogram data available, HF specialist care after discharge from hospital was independently associated with a significant reduction in the composite end point across all LVEF categories (HFrEF: HR 0.577, 95% CI 0.429 to 0.775, p<0.001; HFmrEF: HR 0.485, 0.281-0.834, p=0.009; HFpEF HR 0.762, 0.623-0.931, p=0.008). CONCLUSIONS: HF specialist care after discharge for patients hospitalised with AHF is associated with a significant reduction in the long-term risk of rehospitalisation and all-cause death. This association was present across the three LVEF categories (HFrEF, HFmrEF and HFpEF) and was independent of age and important comorbidities.