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Introduction This was an original Quality Improvement Project (QIP) done at a District General Hospital Coronary Care Unit (CCU). Following the Focused Update on Dyslipidaemia guidance provided by the ESC in 2025, our team decided to evaluate our use of lipid lowering therapies (LLT) during index hospitalisation of acute coronary syndromes (ACS). ESC guidelines advocate aiming for a target LDL-C level of <1.4 mmol/L and to intensify LLT when this is not achieved at Post MI follow-up. Our team was comprised of Resident Doctors and Cardiac Nurse Specialists working in collaboration to improve adherence to ESC guidelines within CCU as well as during Post MI Clinic (PMIC) follow-up.Methods Inclusion criteria involved identifying patients who had presented to our department with an ACS. Patients aged over 85 years old were excluded from the data collection. Following baseline data collection, education sessions were delivered to resident doctors and cardiac nurse specialists in ‘Cycle 1’ of this QIP. In ‘Cycle 2’ posters were displayed in the CCU which included a flowchart of the ESC guidelines. The two complete cycles were undertaken using the ‘Plan Do Study Act’ quality improvement methodology. Clear process, outcome and balancing measures were identified. Process measures included the percentage of patients having LDL-C blood levels measurement on admission and prior to PMIC. Balancing measures included the recognition that increasing LLT usage had the potential to result in increased medication related side effects. The primary outcome measure was the percentage of patients receiving LLT optimisation.Results Baseline data collection of 44 admissions over a 2-month period highlighted that whilst 71% patients were optimised on LLT during index admission, only 38.6% were optimised during PMIC. Data analysis in Cycle 1 included 35 patients presenting to CCU and PMIC, with 81.8% and 54.5% optimised during index admission and PMIC respectively. Data analysis in Cycle 2 included 33 patients, with at 81.8% and 75.8% receiving optimised LLT at index admission and PMIC respectively. The percentage of patients having LDL-C level measurement prior to PMIC was 79.5% at baseline, 81.8% in cycle 1 and 90.9% in cycle 2.Conclusions Following multimodal interventions, we observed a marked improvement in LLT optimisation in patients with ACS. This improvement was greatest at the PMIC stage, reflecting excellent adherence to ESC guidelines by the Cardiac Nurse Specialists. Barriers to optimised LLT included discontinuation of LLT necessitated by adverse medication-related side effects. Factors such as patient attendance to lipid profile testing prior to PMIC were also difficult to optimise: this has been identified as a future area for improvement. Future application of this QIP may extend to providing teaching to other areas within the trust, with a particular emphasis on departments receiving a high volume of patients such as the Acute Medicine Unit.