227 Improving the assessment of cardiovascular risk factors in patients with non-ST elevation acute coronary syndrome: a quality improvement project

Background High intensity lipid lowering therapy decreases the risk of subsequent cardiovascular events following acute myocardial infarction and is recommended by the National Institute for Clinical Excellence guidance. Diabetes is another well-recognised risk factor and is increasing in prevalence globally. Importantly, recent clinical trials have demonstrated the efficacy of glucose-lowering therapies such as SGLT-2 inhibitors and GLP-1 agonists in modifying cardiovascular outcomes. Objective This quality improvement project (QIP) assessed rates of baseline risk factor measurements in patients admitted to a single tertiary cardiology centre with non-ST elevation acute coronary syndrome (NSTE-ACS). The aim of the project was to improve adherence to evidence-based guidelines for secondary prevention of cardiovascular disease. Methods We conducted a retrospective audit of patients admitted to a single tertiary cardiology centre with NSTE-ACS over a one-week period. Patient electronic records were reviewed to extract data at baseline to assess whether HbA1c and lipid profile blood tests were performed during or less than 3 months prior to admission. As the first intervention, the cohort of junior doctors working in the cardiology department were reminded in handover meetings to request these tests for patients presenting with NSTE-ACS. To ensure adherence to the recommendation with future cohorts, the junior doctor induction document was updated. Subsequently, two further one-week retrospective data collection cycles were completed pre and post medical changeover to evaluate the effectiveness of the above interventions. Results The baseline audit showed only 61% (14/23) of patients received HbA1c measurements and 57% (13/23) of patients received lipid profile measurements either as an inpatient or in the 3 months prior to their admission with NSTE-ACS. Following intervention, there was an improvement in HbA1c measurements to 100% (10/10) and an improvement in lipid profile measurements to 90% (9/10). A third audit cycle demonstrated a sustained improvement in both HbA1c and lipid profile measurements at 88% (7/8) and 100% (8/8) respectively. Conclusion Simple verbal reminders and adjustment of written induction material has resulted in a sustained improvement in adherence to guidelines regarding measurement of risk factors in patients with NSTE-ACS. This should subsequently enable improved optimisation of risk factor targets during outpatient follow-up. Conflict of Interest Nil conflict of interest.