Title : Bridging the gap in LDL-C control post-ACS: A quality improvement initiative at a UK tertiary centre
Abstract:
Introduction: Nottingham University Hospitals is a busy tertiary centre and home to the Trent Cardiac Centre, one of the region’s leading hubs for cardiovascular care. With over 2000 patients presenting with Acute Coronary Syndrome (ACS) annually, we recognise that managing the initial event is only part of the journey—effective secondary prevention, particularly lipid management, is crucial in reducing long-term cardiovascular risk.
Method and Results: To evaluate our practice of managing lipids in post-ACS patients, we conducted a retrospective clinical audit of 100 patients admitted with ACS between August 2024 and January 2025. One of the main aims of the study was also to assess the percentage of patients meeting NICE/ESC targets of Lower Density Lipoprotein (LDL) reduction post ACS.
Lipid profiles were checked during admission in 77% of patients. When including those who had lipid testing within 2–3 months after discharge, this increased to 84%. Among those tested, 5 patients had significantly elevated LDL-C levels (>5 mmol/L) and 24 had triglycerides over 2 mmol/L. Prior to their 12 weeks follow up in the post ACS clinic, patients were asked to attend for a repeat lipid test. 83% of patients were compliant with repeat testing, with 11 still showing LDL-C levels above 2.6 mmol/L, and only 16 reaching the recommended target of <1.4 mmol/L. We found that only 2 % of these patients were on additional lipid lowering therapy on top of high dose statins. These results highlight and inertia of treatment and clear opportunities to improve lipid control in this high-risk group.
Conclusion and Action Plan: As a result, we developed a Lipid Management Pathway for Secondary Prevention, which included the recently NICE approved Inclisiran, an injectable therapy that lowers LDL-C by targeting PCSK9. Its safety and efficacy are well established through the ORION 8, 9, 10, and 11 trials. Inclisiran is intended for patients with established cardiovascular disease who are unable to meet LDL-C targets despite optimal oral therapy.
To support its delivery, a structured Standard Operating Procedure (SOP) has been implemented within the Cardiac Short Stay Unit. This includes a clear process for patient identification, consent, prescribing, administration, and follow-up. This audit not only highlighted the need to improve lipid testing in post-ACS patients but also provided the foundation for this new pathway. It reflects our ongoing commitment to enhancing secondary prevention and improving long-term outcomes for our cardiac patients.
