{
  "abstract": "Introduction Every five minutes, a patient is admitted to a UK hospital due to myocardial infarction. 1 Patients with acute coronary syndrome (ACS) remain at significantly high risk of experiencing recurrent cardiovascular events.2 Studies indicate that factors contributing to an increased risk of future cardiovascular events are often overlooked, leading to higher morbidity and mortality rates.3 The current NICE guidelines recommend re-evaluating the lipid profile 2–3 months after hospital admission for ACS. The lipid targets for the secondary prevention of cardiovascular disease (CVD) include LDL cholesterol levels of 2.0 mmol/L or less, non-HDL cholesterol levels of 2.6 mmol/L or less, and fasting triglyceride levels below 1.7 mmol/L. The primary aim of our study was to assess whether the current guidelines and standard practices are being met.Methods and Results A retrospective review of the hospital database was conducted to identify patients admitted with a diagnosis of ACS between May and July 2024. During this three-month period, a total of 100 consecutive patients were included in the study. The median age of the cohort was 69 years, with 70% being male. Notably, 11% of the sample did not have their lipid profile checked upon admission, and only 63% underwent re-evaluation at the recommended 2–3-month follow up.Our laboratory does not provide LDL-C measurements for the majority of patients; therefore, our analysis focused on non-HDL cholesterol targets. We observed that 23% of patients did not meet the NICE non-HDL-C target at the 2–3 months follow-up. Triglyceride management appeared to be even more neglected, with only 17% of patients having their triglyceride levels checked upon admission and 15% at the 2–3 months follow-up. Alarmingly, in 20% of patients, an escalation in lipid therapy was indicated but not appropriately implemented, even in those with markedly out-of-target values.Conclusions Our findings are striking and objectively highlight the challenges faced by a district general hospital in achieving optimal lipid management following ACS. The service is struggling at multiple levels, including lipid testing upon admission, follow-up re-evaluation at the 2–3 months interval, and the completeness of the lipid profile. Additionally, significant clinical inertia was observed, with clinicians demonstrating reluctance to escalate lipid therapy despite guideline-directed recommendations. However, our data served as a catalyst for initiating an awareness-raising campaign through multiple teaching sessions at different levels. It also presents valuable opportunities to enhance the existing infrastructure, particularly by strengthening the role of specialist nurses and pharmacists in lipid management through the establishment of a nurse-led post-ACS lipid clinic aimed at achieving the recommended national lipid targets.References British Heart Foundation UK factsheet January 2025.Steen DL, Khan I, Andrade K, Koumas A, Giugliano RP. Event rates and risk factors for recurrent cardiovascular events and mortality in a contemporary post acute coronary syndrome population representing 239 234 patients during 2005 to 2018 in the United States. J Am Heart Assoc. 2022 May 3;11(9):e022198.Khan Z, Rakhit R. Secondary prevention lipid management following ACS: a missed opportunity? Br J Cardiol. 2022 Nov 9;29(4):35.",
  "authors": [
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "Younan Samuel"
    },
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "Ahmed Elkasabany"
    },
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "Cassie Pain"
    },
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "Adam Khan"
    },
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "John Cornish"
    },
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "Sara Ali"
    },
    {
      "affiliations": [
        "William Harvey Hospital, Ashford, Kent, UK"
      ],
      "name": "Asrar Ahmed"
    }
  ],
  "title": "7-035 Optimizing lipid management following ACS: mitigating adverse outcomes by achieving target levels – a quality improvement initiative",
  "uid": "2e6fe0bd-7a9f-5313-8d4b-5639fff31ee0"
}