Highlights
- •CirrhoCare® achieved good patient engagement and positive user feedback for the remote home management of decompensated cirrhosis.
- •The system detects early signs of new decompensation and enables timely intervention.
- •Remotely managed patients had fewer admissions than controls and improved disease severity scores over 10 weeks.
- •CirrhoCare® may aid hepatologists with the early diagnosis of new post-discharge decompensations.
Background & Aims
Individuals with cirrhosis discharged from hospital following acute decompensation
are at high risk of new complications. This study aimed to assess the feasibility
and potential clinical benefits of remote management of individuals with acutely decompensated
cirrhosis using CirrhoCare®.
Methods
Individuals with cirrhosis with acute decompensation were followed up with CirrhoCare®
and compared with contemporaneous matched controls, managed with standard follow-up.
Commercially available monitoring devices were linked to the smartphone CirrhoCare®
app, for daily recording of heart rate, blood pressure, weight, % body water, cognitive
function (CyberLiver Animal Recognition Test [CL-ART] app), self-reported well-being,
and intake of food, fluid, and alcohol. The app had 2-way patient–physician communication.
Independent external adjudicators assessed the appropriateness of CirrhoCare®-based
decisions.
Results
Twenty individuals with cirrhosis were recruited to CirrhoCare® (mean age 59 ± 10
years, 14 male, alcohol-related cirrhosis [80%], mean model for end-stage liver disease–sodium
[MELD-Na] score 16.1 ± 4.2) and were not statistically different to 20 contemporaneous
controls. Follow-up was 10.1 ± 2.4 weeks. Fifteen individuals showed good engagement
(≥4 readings/week), 2 moderate (2–3/week), and 3 poor (<2/week). In a usability questionnaire,
the median score was ≥9 for all questions. Five CirrhoCare®-managed individuals had
8 readmissions over a median of 5 (IQR 3.5–11) days, and none required hospitalisation
for >14 days. Sixteen other CirrhoCare®-guided patient contacts were made, leading
to clinical interventions that prevented further progression. Appropriateness was
confirmed by adjudicators. Controls had 13 readmissions in 8 individuals, lasting
a median of 7 (IQR 3–15) days with 4 admissions of >14 days. They had 6 unplanned
paracenteses compared with 1 in the CirrhoCare® group.
Conclusions
This study demonstrates that CirrhoCare® is feasible for community management of individuals
with decompensated cirrhosis with good engagement and clinically relevant alerts to
new decompensating events. CirrhoCare®-managed individuals have fewer and shorter
readmissions justifying larger controlled clinical trials.
Impact and implications
As the burden of cirrhosis grows worldwide, increasing demands are being placed on
limited healthcare resources, necessitating the adoption of more sustainable care
models that allow for at-home patient management. The CirrhoCare® management system
was developed to fill this care gap, deploying a novel combination of hardware, apps,
and algorithms, to monitor and intervene in individuals at risk of new decompensation.
This study highlights the possibility of reducing hospital readmissions for cirrhosis
by optimising specialist community care, reducing the need for interventions such
as paracentesis, while providing a more sustainable care pathway that is acceptable
to patients. However, given the pilot and non-randomised nature of this study, the
outcomes require further validation in a larger randomised controlled trial, to assess
both clinical effectiveness and cost-effectiveness. Moreover, the data generated will
also facilitate data modelling and further research to refine the CirrhoCare® algorithms
to increase their detection sensitivity and utility.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 07, 2022
Accepted:
August 11,
2022
Received in revised form:
August 10,
2022
Received:
January 25,
2022
Footnotes
Author names in bold designate shared co-first authorship.
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.
