Closing the secondary prevention gap in acute coronary syndrome through system-level metabolic risk standardisation
A Roy, B SaberwalAbstract
Background
Early identification of dysglycaemia and dyslipidaemia is essential for optimising secondary prevention after acute coronary syndrome (ACS). National guidance mandates HbA1c and lipid profile testing during admission; however, real-world adherence and inter-site variation remain suboptimal.
Purpose
To evaluate compliance with guideline-directed metabolic screening in ACS admissions and determine whether a structured system-level intervention improves adherence and reduces variation across two hospital sites.
Methods
A quality improvement project was conducted across two acute hospital sites within one healthcare Trust. Two audit cycles included 200 consecutive ACS admissions (100 per cycle; 50 per site). Baseline compliance was assessed against a 100% standard. Gaps included absence of pathway integration and inter-site practice variation. A structured intervention comprising multidisciplinary education, visual prompts, audit feedback, and pathway reinforcement was implemented. Re-audit occurred three months later. Proportions were compared using Fisher’s exact test.
Results
Baseline compliance was low, with HbA1c testing performed in 20% and lipid profile testing in 48% of ACS admissions. Following intervention, HbA1c testing increased to 74% (+54% absolute increase; p=1.21×10-12) and lipid testing to 79% (+31% absolute increase; p=1.02×10-5), demonstrating statistically robust improvement in guideline adherence.
Conclusion
Failure to embed metabolic screening within ACS pathways represents a modifiable secondary prevention gap. A structured, low-cost intervention produced statistically robust improvement and reduced variation. Closing this gap at the point of ACS admission provides a scalable model for system-level cardiovascular risk optimisation.Lipid profile, Hba1c test