Secondary prevention lipid management after ACS at a DGH: a quality improvement project

Lipid management is a key component of secondary prevention after acute coronary syndrome (ACS), but guideline adherence is variable. Adjunctive lipid-lowering therapies (LLTs) beyond statins are available, yet eligibility in the real-world setting is not well-described. We aimed to improve local post-ACS lipid management, and evaluate eligibility for LLTs. Consecutive admissions of patients with ACS to a district general hospital from April to June 2022 were assessed for: inpatient lipid-profile assessment, inpatient LLT management, and outpatient repeat lipid profiles. A structured intervention, including updating blood testing panels, education, and reference resources, was implemented. We re-audited admissions in April-June 2024, where eligibility for adjunctive LLTs was assessed. There were 97 (cycle 1) and 102 (cycle 2) patients identified. While performance was suboptimal in cycle 1, we observed improvements in cycle 2 (baseline full lipid profile testing from 10% to 75%; appropriate LLT management 65% to 78%; post-discharge repeat testing 37% to 63%). At one year post-ACS, 35% of patients remained subtherapeutic, but medication changes were rare. In conclusion, through use of a structured intervention, we were able to improve post-ACS lipid management. Many patients fail to achieve therapeutic lipid lowering. Strategies to address this are urgently required.