ESCP Spring Workshop 2023: Advancing clinical pharmacy and care in diabetes and cardiovascular comorbidities—Antwerp, 20–21 April 2023

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TL;DR

This supplement from the ESCP Spring Workshop 2023 presents 20 abstracts covering clinical pharmacy advances in cardiovascular disease and diabetes. Key findings include pharmacist-led bleeding risk assessment improving antiplatelet therapy personalization after PCI, significant drug interactions between amiodarone and edoxaban in cardioversion patients, and high rates of potentially inappropriate prescribing in elderly and diabetic patients. The collection demonstrates clinical pharmacists' growing role in medication optimization, deprescribing, and patient education across hospital and community settings.

Full summary

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**Background:** The ESCP Spring Workshop 2023, held in Antwerp on 20–21 April 2023, focused on advancing clinical pharmacy and care in diabetes and cardiovascular comorbidities. The supplement includes 4 oral communications and 16 poster presentations covering a wide range of topics including antithrombotic therapy optimization, direct oral anticoagulant monitoring, oral anticancer drug management, prescription verification practices, diabetes care, and medication safety.

**Methods:** The studies employed diverse methodologies. Formosa et al. conducted a prospective cohort study of 137 patients undergoing PCI, using the PRECISE-DAPT score to assess bleeding risk and optimize DAPT duration. Gavrilova et al. performed a cross-sectional pilot study measuring DOAC concentrations in 38 patients undergoing cardioversion, using chromogenic anti-Xa and anti-IIa assays. Wuyts et al. reviewed 2.5 years of pharmacist consultations for oral anticancer drugs at a Belgian academic hospital. De Keyser et al. conducted a nationwide survey of 49 Belgian hospitals on prescription verification practices. Several studies used systematic review methodology: Érszegi et al. performed a network meta-analysis of 34 RCTs on imidazoline receptor agonists; Maklad et al. systematically reviewed 26 studies on patient ADR reporting using the Theoretical Domains Framework. Other studies included retrospective observational designs (Bellato et al., Campanardi et al.), cross-sectional analyses (Nguyen-Hoang & Mai, Soylemez et al.), case reports (Feka et al.), and Delphi consensus methods (Gossery et al.).

**Key Results:** Formosa et al. found that 42% of PCI patients were high bleeding risk; 64% were discussed with cardiologists, and short-term DAPT was prescribed in 37 of these cases. During 1-year follow-up, 51.8% experienced negative outcomes, with minor bleeding significantly higher in short-term DAPT (7.3% vs 3.6%, p=0.013). Gavrilova et al. detected higher-than-expected DOAC concentrations in 3 rivaroxaban and 7 edoxaban users; among edoxaban users receiving amiodarone, 100% (5/5) had elevated concentrations vs 25% (2/8) without amiodarone (OR=15.0, p=0.021). Wuyts et al. reported 386 patients (61%) received pharmacist education at OACD first delivery, with targeted therapies most common (41%). De Keyser et al. found 90% of Belgian hospitals had prescription verification systems, 64% coupled with CDSS, but 35% lacked access to medical files. Bellato et al. reported evolocumab reduced LDL-C by 47% at 24 weeks and 58% at 48 weeks in 76 patients. Érszegi et al. found guanfacine produced the largest SBP/DBP reduction vs placebo (MD: −23.60/−14.30 standing at 4 weeks), while dry mouth was highest with clonidine (OR: 9.27) and lowest with rilmenidine (OR: 6.46). Nguyen-Hoang & Mai reported 77% physician adherence to diabetes prescribing guidelines, independently associated with HbA1c target achievement (OR=3.25, 95% CI 1.66–6.39, p=0.001). Ruiz-Molina et al. detected PIPs in 61.9% of elderly diabetic patients. Soylemez et al. found 48.3% of diabetic patients were non-adherent, with higher HbA1c in non-adherent patients (9.7% vs 8.1%, p=0.018). Prášilová et al. identified PIMs in 85% of elderly hospitalized patients using three assessment tools. Hromníková et al. found 81% of pulmonary hypertension patients carried at least one CYP450 variant allele.

**Clinical Implications:** The studies collectively demonstrate that clinical pharmacist interventions improve medication optimization across multiple domains. Pharmacist-led bleeding risk assessment using PRECISE-DAPT can personalize antiplatelet therapy post-PCI. The significant amiodarone-edoxaban interaction identified warrants monitoring in cardioversion patients. High rates of potentially inappropriate prescribing in elderly and diabetic patients highlight the need for pharmacist-led medication review and deprescribing. The integration of clinical pharmacists into multidisciplinary teams for diabetes management, anticoagulation monitoring, and cancer care can improve outcomes. The survey data on prescription verification practices provide a baseline for standardization. The pharmacogenetic data suggest potential for personalized therapy in pulmonary hypertension. The systematic reviews on ADR reporting and disaster preparedness identify gaps for future intervention development.