An audit to review the prescribing and monitoring of high-intensity statin therapy in acute coronary syndrome patients

Abstract

Abstract Introduction High-intensity statin therapy (HIST) is recommended as secondary prevention following an acute coronary syndrome (ACS). Prior to initiating a statin, a baseline liver function test (LFT) and lipid profile are required, which should be repeated in primary care after 3 months for safety purposes and to measure efficacy. Targets to measure efficacy are defined as part of local, national[1] and European guidance.[2] Aim To investigate if a National Health Service (NHS) Health Board are compliant with current guidance on the prescribing and monitoring of HIST in ACS patients. Methods A retrospective audit of all new ACS diagnoses in the NHS Ayrshire & Arran in June 2022 was undertaken using inpatient prescribing data. The Clinical Portal system was used to obtain LFT and lipid profile results and these were recorded in Microsoft Excel for analysis. Results The patient cohort (n=57) was 58% male, with a mean age of 69 years. LFTs were measured in 96.5% patients on admission and 84.2% at follow-up. Conclusion HIST with Atorvastatin 80mg was initiated in most cases (84.2%), with appropriate clinical exceptions. HIST appeared effective with 78.9% of patients achieving a 40% reduction in non-HDL cholesterol and 63% of patients achieving an LDL-C target of <1.8mmol/L. These results highlight the need for clinical review at 3 months to optimise lipid lowering therapy as 37% of patients had not met an LDL-C target of <1.8mmol/L. Interpretation of this data is limited by small sample size due to limited allocation of time for data collection and by the fact that not all patients had both baseline and follow-up lipid profiles taken so it cannot be determined if they met treatment targets (n=38). There is a need for the NHS Health Board to improve lipid profile monitoring of HIST as although LFTs were measured in 96.5% patients on admission and 84.2% at follow-up, only 73.7% had a baseline lipid profile and 47.4% at follow-up. As both are measured using the same blood sample, it is suggested that targeted clinician education regarding lipid profile requesting alongside LFTs could significantly improve adherence to audit standards.