Lipid screening and treatment after acute coronary syndrome – the chasm between guidelines and real-life practice in a tertiary care center in Sri Lanka

Cardiovascular disease (CVD) remains the leading cause of death in Sri Lanka. Dyslipidaemia is a risk factor for CVD. Guidelines on dyslipidaemia recommends checking lipid levels in all patients admitted with acute coronary syndrome (ACS) and initiation of early high-intensity lipid-lowering therapy.

 

Patients admitted to the medical units of Colombo South Teaching Hospital were audited with two audit standards based on The National Institute of Health and Care Excellence (NICE) and European Society of Cardiology (ESC) guidelines. Audit Standard one – All patients with ACS to have cholesterol measured within 24 hours of admission.

 

Audit Standard two – All patients to be given highintensity lipid-lowering therapy post ACS.

 

First audit cycle was during May-June 2020. Thereafter, the doctors were educated about the NICE and ESC guidelines and re-audited between July-September 2020 (2^nd cycle) closing the audit loop.

 

Both cycles had 200 patients each. In 1^st cycle, during the first 24 hours, 31 (15.5%) patients had their total cholesterol (TC) and 2 (1%) had a full lipid profile performed. During 2nd cycle, 66 (33%) patients had their TC and 11 (6.5%) had a full lipid profile. Between the two cycles there was a statistically insignificant increase in lipid testing.

 

In 1st cycle, high dose statins were prescribed in 199 (99.5%) and in 2^nd cycle, 197 (98.5%) patients. Hence high adherence to prescribing statins was seen. The lower number in the re-audit was due to comorbidities which prevented high-intensity statins.

 

Testing of lipids after ACS is poor and not keeping with above guideline recommendations. This study highlights the need for continuous education and motivation of doctors to improve adherence to guidelines on lipid screening in ACS. The usage of statins for secondary prevention is commendable.