Key result
Targeted quality improvement strategies boost post-ACS LDL-C target attainment by ~6 percentage points.
Why the study?
Despite wider availability of novel lipid-lowering therapies and increasingly stringent ESC guideline recommendations, adherence to and achievement of guideline-directed LDL-C targets after ACS remain inconsistent.
Do targeted quality improvement strategies improve inpatient lipid profiling, 3-month repeat lipid testing, and LDL-C target attainment in patients admitted with acute coronary syndrome?
Cohort (n=484)
No
Do targeted quality improvement strategies improve inpatient lipid profiling, 3-month repeat lipid testing, and LDL-C target attainment in patients admitted with acute coronary syndrome?
Structured quality improvement interventions substantially increased post-ACS inpatient and 3-month follow-up lipid testing at a UK tertiary center, though two-thirds of patients still failed to achieve the contemporary LDL-C target of <1.4 mmol/L.
Suboptimal LDL-C target attainment signals need for better implementation; challenges guideline feasibility and extends research on combination therapies.
Background Effective lipid management is a fundamental pillar of secondary prevention following acute coronary syndrome (ACS). Over the past decade, the field has evolved rapidly, with the introduction of novel lipid-lowering therapies, now widely available to the UK population. This therapeutic expansion has been accompanied by increasingly stringent low-density lipoprotein (LDL) cholesterol targets in European Society of Cardiology (ESC) guidelines, reflecting the growing recognition of intensive lipid reduction in improving cardiovascular outcomes. However, despite clear and robust recommendations, adherence and achievement of guideline-directed LDL targets remain inconsistent. Purpose To compare trends in lipid testing and LDL-C target attainment over a 10-year period in patients admitted with ACS at a UK tertiary centre. Methods This retrospective observational comparative study included two ACS cohorts (2015/16, n = 284; 2025/26, n = 200). Within each cohort, patients were stratified into pre- and post-intervention groups to assess the impact of targeted quality improvement strategies. In 2015/16, the intervention involved the development of local lipid management guidelines for post-ACS follow-up and structured referral pathways to specialist lipid clinics. In 2025/26, guidelines were updated to incorporate newer agents (bempedoic acid and icosapent ethyl), pathology request forms were posted directly to patients to facilitate follow-up testing, and an Inclisiran service was established. We evaluated rates of inpatient lipid profiling, repeat lipid measurement at three months, and attainment of guideline-recommended LDL-C targets before and after intervention. Results The mean age for the 2015/16 cohort was 62.2 ± 12.3 years, compared to 67.1 ± 12.4 years in the 2025/26 cohort. Inpatient lipid testing improved from 80% to 93% in 2015/16 and from 77% to 96% in 2025/26 following intervention. Follow-up lipid testing increased from 31% to 37% in 2015/6 and reached 83% in the 2025/26 cohort. In 2015/16, 62% of patients were deemed to have met lipid targets then of LDL-C <1.8 mmol/L. When compared with current lipid targets of LDL-C <1.4mmol/L, only 26% met targets. In the 2025/26 cohort, 32% achieved LDL-C <1.4mmol/L. 2% of eligible patients with hypertriglyceridemia received Icosapent Ethyl. Conclusion(s) Over the past decade, structured interventions have improved inpatient and follow-up lipid testing following ACS. While incorporation of newer therapies has modestly increased attainment of contemporary LDL-C targets, a substantial gap persists. Continued systematic, protocol-driven approaches are required to align clinical practice with evolving guideline standards.
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Thomas et al. (2026) conducted a cohort in Acute coronary syndrome (n=484). Targeted quality improvement strategies for lipid management (updated guidelines, newer agents, direct patient pathology forms, Inclisiran service) vs. Pre-intervention standard care / 2015/16 cohort was evaluated on Attainment of contemporary guideline-recommended LDL-C target (<1.4 mmol/L) at 3 months. Targeted quality improvement strategies increased 3-month follow-up lipid testing to 83% and LDL-C <1.4 mmol/L target attainment from 26% (2015/16) to 32% (2025/26) post-ACS.
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