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Background Lipid management is a key component of secondary prevention after acute coronary syndrome (ACS). In recent years, novel lipid-lowering therapies (LLTs) have emerged, including proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i, monoclonal antibodies and inclisiran), 1 and icosapent ethyl (IPE) for hypertriglyceridaemia.2 3 Studies pre-dating these agents have reported poor secondary prevention lipid management in the United Kingdom.4 5 We aimed to assess and improve local lipid management in patients with ACS. Furthermore, we sought to assess real-world eligibility for inclisiran and IPE in this setting.Methods Consecutive patients admitted with ACS in April-June 2022 (initial audit) and April-June 2024 (reassessment) were included. A PDSA approach was employed, with interim assessment, action plan formulation, and implementation. Quality metrics were assessed in line with NICE guideline NG238: 6 i. Baseline assessment with a full lipid profile (including non-high-density lipoprotein cholesterol [non-HDL-C]), ii. Escalation of LLT to a maximum-dose high-intensity statin (e.g. atorvastatin 80mg) unless contraindicated, iii. Repeat full lipid profile assessment within three months post-discharge.Eligibility for inclisiran and IPE were assessed for the April-June 2024 cohort, following relevant NICE technology appraisals (TA733 and TA805).7 8 Abstract 7-024 Table 1Baseline characteristics. High-intensity defined as per NICE Guideline NG238, i.e. agent and dose with ≥40% low-density-lipoprotein cholesterol lowering capacity. CVD, cardiovascular disease, LLT, lipid-lowering therapy. Cycle 1 (n=97) Cycle 2 (n=102) Mean age, years (standard deviation) 67.7 (13.5) 69.6 (12.6) Female, n (%) 29 (30) 32 (31) Admission lipid-lowering therapy High-intensity LLT, n (%) 42 (43) 51 (50) Non-high-intensity LLT, n (%) 8 (8) 10 (10) No LLT, n (%) 48 (49) 41 (40) Co-morbidities/ cardiovascular risk factors Known CVD, n (%) 41 (42) 45 (44) Hypertension, n (%) 56 (58) 67 (66) Smoking history, n (%) 52 (54) 45 (44) Diabetes mellitus, n (%) 28 (29) 31 (30) Results 97 and 102 eligible patients were identified ( table 1). Key performance metrics are summarised in table 2. On initial audit, only 10% underwent full lipid profile testing on admission, and LLT was appropriately managed in 65%. After discharge, only 37% of patients underwent repeat non-HDL-C testing within three months.Abstract 7-024 Table 2Summary of performance in audited metrics across the two cycles. Statistical tests performed using the chi-squared test. Non-HDL-C, non-high-density lipoprotein cholesterol. Cycle 1 (n=97) Cycle 2 (n=102) P value Admission lipid profile testing Full lipid profile, n (%) 10 (10) 76 (75) <0.001 Total cholesterol only, n (%) 77 (80) 16 (16) Not assessed, n (%) 10 (10) 10 (10) Inpatient management of LLT Appropriate escalation/ management, n (%) 63 (65) 80 (78) 0.035 Inappropriate management, n (%) 34 (35) 22 (22) Outpatient re-assessment within 3 months Any repeat testing within 3 months , n (%) 52 (54) 70 (69) Repeat test with non-HDL-C within 3 months , n (%) 36 (37) 64 (63) <0.001 Our intervention included: i. inclusion of full lipid profiles in the ACS blood test careset, ii. resident doctor education, iii. use of a standardised discharge letter template, and iv. generation of a departmental guide for LLT.After intervention, there were significant improvements in admission full lipid profile testing (76/102, 75%, p<0.001), and LLT management (80/102, 80%, p=0.035). After discharge, a greater proportion of patients underwent repeat non-HDL-C assessment within three months (64/102, 63%, p<0.001).Using the last available full lipid profile, post-discharge therapeutic non-HDL-C control (<2.5 mmol/L) was achieved in a non-significant higher proportion of patients in cycle 2 (52/80 [65%], vs cycle 1 35/66 [53%], p=0.14). In cycle 2, 3% (2/80) of patients with repeat non-HDL-C were eligible for inclisiran, and 28% (13/47) with triglyceride re-measurement were eligible for IPE (figures 1 and 2).Abstract 7-024 Figure 1Eligibility for inclisiran. All measurements are in mmol/L. LDL-C, low-density lipoprotein cholesterol, non-HDL-C, non-high-density lipoprotein cholesterol. Images created with the assistance of SankeyMATIC.com.Abstract 7-024 Figure 2Eligibility for icosapent ethyl. All measurements are in mmol/L. IPE, icosapent ethyl, LDL-C, low-density lipoprotein cholesterol, non-HDL-C, non-high-density lipoprotein cholesterol, TG, triglycerides. Images created with the assistance of SankeyMATIC.com.Conclusion Through structured intervention, we improved local lipid assessment and management in patients with ACS, with downstream effects on repeat testing, though further improvements are possible and required. A third of patients are not at target non-HDL-C at re-assessment. A quarter of re-assessed patients are eligible for triglyceride-lowering therapy.References Ray KK, Wright RS, Kallend D, et al. Two phase 3 trials of inclisiran in patients with elevated LDL cholesterol. New Engl J Med 2020;382:1507–1519.Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertryglyceridaemia. New Engl J Med 2019;380:11–22.Gaba P, Bhatt DL, Steg PG, et al. Prevention of cardiovascular events and mortality with icosapent ethyl in patients with prior myocardial infarction. J Am Coll Cardiol 2022;79:1660–1671.Aubiniere-Robb L, Dickerson JE, Brady AJB. Lipid testing and treatment after acute myocardial infarction: no flags for the flagship. Br J Cardiol 2019;26:141–144.Salim HY, Lwin K, Khoo C, Wilson D. Management of hyperlipidaemia following acute coronary syndrome: a retrospective audit. Br J Cardiol 2021;28:62–66.Cardiovascular disease: risk assessment and reduction, including lipid modification (2023) NICE guideline NG238. Available from: https://www.nice.org.uk/guidance/ng238 Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia (2021) NICE TA 733. Available from: https://www.nice.org.uk/guidance/ta733 Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides (2022) NICE TA 805. Available from: https://www.nice.org.uk/guidance/ta805