221 Icosapent ethyl initiation amongst patients with acute coronary syndrome: recommended, yet underutilised

Introduction The 2022 NICE guidelines for Acute Coronary Syndrome (ACS) recommend Icosapent Ethyl (IPE) in patients with fasting triglyceride (TG) levels of 1.7 mmol/l or above and LDL levels between 1.04 and 2.60 mmol/litre, despite statin treatment. Reinforced by a 37% decrease in major cardiovascular events observed among patients randomised to IPE in the REDUCE-IT trial, the extent to which this recommendation is followed in clinical practice remains uncertain. This study aimed to gauge adherence to NICE technology appraisal TA805 on initiating IPE in eligible patients. Methods We conducted a retrospective electronic medical record analysis of patients diagnosed with ACS discharged between January and July 2023 at a teaching hospital in Wakefield, UK. The dataset includes admission and post-discharge lipid profiles, prescriptions for statins and IPE, cardiovascular risk factors, and any discharge instructions relayed to the general practitioner (GP). Lipid assessments were categorised as 'missed' if not done within 4 months of discharge. IPE eligibility was assessed pre- and post-discharge using NICE eligibility criteria (figure 1). Results We identified 193 patients (67% male, mean age 67) discharged with a diagnosis of ACS during the study period. A total of 191 patients had TG measurements on admission allowing assessment for IPE suitability. 32 patients had high TG on admission; 24 of these patients were already established on statins thus being eligible for IPE as in-patients. Inadequate post-discharge lipid profiling limited an analysis of potential suitability for IPE therapy with only 19% of patients having repeat TG in the community. In primary care, cholesterol alone was monitored in 30% of patients rather than a full lipid profile. After discharge, an additional 6 patients became eligible for IPE: 1 was newly prescribed a statin during hospitalisation and 5 had normal TG levels upon admission but later developed hypertriglyceridemia. In total, 30 patients (16%) were eligible for IPE within 4 months of discharge (summarised in figure 1). Only one of these patients received a prescription for IPE. 91% of discharge letters lacked instructions for the GP to consider IPE or repeat lipid profiling. Conclusion Despite NICE guidance recommending IPE in eligible patients since 2022, the drug is rarely considered following ACS at a large teaching hospital in Wakefield, UK. Our analysis confirms failures in both primary and secondary care to consider IPE prescription in high-risk patients post-ACS. Conflict of Interest None