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Introduction High-intensity statins (HIS) are a cornerstone of secondary prevention in patients with coronary artery disease (CAD), yet real-world implementation of guideline-directed lipid management remains inconsistent. European Society of Cardiology (ESC) guidance recommends HIS for patients with established atherosclerotic cardiovascular disease to decrease the risk of recurrent cardiovascular events and improve outcomes. This audit aimed to evaluate local adherence to ESC-recommended HIS prescribing at hospital discharge, and to assess the impact of a targeted educational intervention on prescribing practices.Methods A retrospective clinical audit was conducted including adult patients with established CAD admitted under the cardiology service of a tertiary care centre between June and July 2024. Data was collected on patient demographics, clinical characteristics, CAD management strategy, and statin prescriptions at discharge. Following the initial audit, a multifaceted intervention was implemented, including clinician education and reinforcement of guideline-based prescribing. A re-audit was performed six months later using identical inclusion criteria. The primary outcome was the proportion of patients discharged on HIS therapy, with comparisons made between pre- and post-intervention cohorts.Results A total of 132 patients were included in the initial audit and 73 patients in the re-audit. Baseline demographic and clinical characteristics were comparable between cohorts. At baseline, 78.8% of patients were discharged on HIS therapy, while 21.2% received either low-intensity statins or no statin. Following the intervention, HIS prescribing increased significantly to 93.2% (p = 0.003). The greatest improvements were observed among females (70.6% to 100%, p = 0.004), older patients (60.0% to 90.5%, p = 0.02), and medically managed patients (56.1% to 93.8%, p = 0.011). Prescribing of low-intensity statins decreased from 15.2% to 5.5% (p = 0.043), and no patients were discharged without statin therapy following the intervention.Conclusions In this tertiary cardiology service, baseline adherence to ESC-recommended HIS prescribing at discharge was moderate, with a substantial proportion of patients discharged on suboptimal lipid-lowering therapy particularly among women and elderly patients. A focused educational intervention successfully bridged this gap, resulting in a statistically significant improvement in HIS prescribing and the elimination of statin omission at discharge. These findings underscores the effectiveness of targeted feedback and staff engagement in driving practice change. Ongoing reinforcement and improved documentation are essential to sustain these gains and ensure guideline-concordant care for all CAD patients.Abstract 497 Figure 1High-intensity statin prescription rates by subgroupAbstract 497 Table 1Patient demographics and clinical characteristicsVariableInitial auditReauditTotal number of patients13273AgeMean (years)66.966.5<65 years54 (40.9%)31 (42.5%)65-74 years33 (20%)21 (28.8%)≥75 years45 (34.1%)21 (28.8%)SexMale98 (74.2%)51 (69.9%)Female34 (20.8%)22 (30.1%)CAD Management StrategyPCI74 (56.1%)37 (50.7%)Medical41 (31.1%)16 (21.9%)Surgical17 (12.9%)20 (27.4%)Abstract 497 Figure 2Statin type prescribed at discharge (pre- and post-intervention)Abstract 497 Table 2High-intensity statin prescription rates by subgroupSubgroupPrescribed HIS Pre (n)Prescribed HIS post (n)p-valueTotal Patients104 (78.8%)69 (93.2%)0.003Age Group<65 years49/54 (90.7%)31/31 (100%)0.08165-74 years28/33 (84.8%)19/21 (90.5%)0.693≥75 years27/45 (60%)19/21 (90.5%)0.02SexMale80/98 (81.6%)47/51 (92%)0.095Female24/34 (70.6%)22/22 (100%)0.004CAD Management StrategyMedical23/41 (56.1%)15/16 (93.8%)0.011PCI66/74 (89%)36/37 (97.3%)0.267Surgical15/17 (88.2%)18/20 (90%)1.00