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Background: We assessed if patients presenting with acute coronary syndromes (ACS) were better treated with statins prior to hospitalisation and the effect on total cholesterol (TC) with time. Method: Australian patients with discharge diagnosis of ACS enrolled in the Global Registry of Acute Coronary Events (GRACE, 1999–2007, n= 4069) and The Cooperative National Registry of Acute Coronary Care Guideline Adherence and Clinical Events (CONCORDANCE, 2009–2010, n= 777) were included. Yearly change in initial admission TC and statin use prior to hospitalisation were assessed and adjusted for temporal change in demographic characteristics, background cardiac history 140 The FHWA Program: Nurse-led Cascade Screening for Familial Hypercholesterolaemia (FH)

cost of common investigations ordered in ED and completed within 30 days of initial ED visit. Methods: This prospective cohort study recruited patients admitted to a major metropolitan ED for syncope over a 14-week period. Clinical history and examination, ED investigations, and discharge diagnosis were recorded in a structured data form. Patients were followed up after 30 days for outcomes of additional investigations and changes to the provisional diagnosis and management. Results: Seventy-one consecutive patients were enrolled. Seventy had a 12-lead electrocardiogram, which yielded the diagnosis in 6 instances (8.5%). Four out of 23 (17.4%) patients on cardiac monitoring for more than 24h had a significant arrhythmia. Other investigations and their diagnostic yield (in brackets) were cardiac monitoring for less than 24h (0%), transthoracic echocardiography (14.3%), Holter monitoring (0%), head CT (7.1%), brain MRI (0%), and EEG (20%). Troponin-I levels were significantly elevated in 3 of 39 cases (7.7%). Certain investigations performed routinely included full blood count, random blood glucose, and chest X-ray, and had low diagnostic yields (4.5%, 0%, and 0%, respectively). Conclusion: The ED assessment of syncopal patients is rendered difficult by the diversity of possible causes and resource constraints. Lack of a standardised diagnostic protocol leads to ordering from a wide array of investigational tools, a number of which come at a cost not justified by their low diagnostic yield. doi:10.1016/j.hlc.2009.05.218

1474 pts. 902 pts were admittedwith ACS, of whom 274 pts were transferred from another hospital. We analysed the 628 ACS admissions from the ACH catchment area. Results: 208 pts were admitted with a STEMI, 331 pts a NSTEMI and 89 pts with unstable angina pectoris (UAP). Themean agewas 66.1± 13.7 years, 395 (62.9%)weremale. The total number of tpn T tests performedwas 1811, mean 2.9 (SD1.1), median 3(IQR 2-3), with a range of 1–8 tests per pt. If 2 testshadbeenperformedperpt, as recommendedby theNZACSGuidelines,wewouldhave seen 1256 tests at a cost of $15,687. In fact, we found that there were 1811 tests performed, at a total cost of $22,619, an extra cost to the CCUof$6932overa13month timeperiod. 381patientshad > 3 tpn tests performed. (We have not taken into account pts who had further episodes of chest pain on the CCU.) Conclusion: Unnecessary blood tests performed in the CCU are costly in a constrained health service. We found that 555 ‘extra’ tpn T testswere performed over a 13month time period. More judicious use of blood tests would have a significant cost saving for a hospital. doi:10.1016/j.hlc.2009.05.229