228 Management of lipid profile in patients presenting with acute myocardial infarction: a retrospective audit on target achievement following the update in nice guidance

Introduction Acute coronary syndrome (ACS) is a leading cause of hospitalisation in the UK. Reducing cholesterol levels in acute MI patients impedes the progression of atherosclerosis and reduces the risk of future cardiac events. There are several guidelines from the National Institute for Health and Care Excellence (NICE) regarding the management of a patient's lipid profile after their diagnosis. Purpose to assess what proportion of patients with an ACS have guideline directed treatment. Methods We undertook a retrospective audit at the Queen Elizabeth Hospital in Birmingham. Our sample population was all patients admitted with ACS between 1 April 2022 and 1 April 2023. The NICE standards which we audited against were: 1.Is Atorvastatin 80 mg administered regardless of their cholesterol level? 2. Is a full lipid profile measured on admission and at 3 months? 3. Are additional lipid-lowering treatments (PCSK9i, ezetimibe and inclisiran) considered if the maximum tolerated dose and intensity of statin is achieved when the LDL-C > 2.0 mmol/l for secondary prevention of CVD? We identified 667 people who had been admitted with ACS between the dates of 1 April 2022 and 1 April 2023. 49 individuals were excluded due to mortality before the designated window for assessing their LDL-C levels. Patient data was gathered from medical records utilising a web-based laboratory results reporting system, as well as shared care records from general practitioners (GPs), to evaluate blood test results and relevant documents, including discharge letters. Results We found a strong adherence to the first standard we were assessing, with 94% of patients being discharged on lipid-lowering therapy. Among these, 91% were prescribed the recommended 80 mg Atorvastatin, while 3% were provided with an alternative lipid-lowering therapy in cases where Atorvastatin was contraindicated due to allergy or an undocumented reason. Lipid monitoring on admission was rigorously adhered to, with 98.7% of patients having their LDL-C checked as part of a full lipid profile. However there was a dramatic fall in adherence with the second NICE standard which recommends a further lipid profile at 3 months - only 13.5% were checked again (at 3 months ± 2 weeks). On average, patients were next seen 131 days after discharge - significantly beyond the 3 month window. The majority of patients (75.4%) had their lipid levels rechecked however 24.6% of patients were never seen again. 151 patients met criteria and were eligible for further escalated treatment, however only 41(27%) were actually commenced on an additional medication. Conclusion Effective management of a patient's lipid profile is crucial for ensuring favourable future outcomes, our findings indicate inadequate adherence to national guidelines particularly in re-testing and considering additional therapies if targets are not met. Conflict of Interest None