Health UK (Commonwealth Union) – A trial led by the University College London (UCL) and the Royal Free Hospital, London, will assess a smartphone-enabled management system designed to enhance the care of patients with severe liver disease upon discharge from the hospital. Known as CirrhoCare, the system targets individuals with advanced cirrhosis, a group at high risk of severe health issues, with 37% facing readmission within a month.
CirrhoCare comprises a patient-facing app linked to smart devices, capturing complications related to cirrhosis. It empowers clinicians to remotely monitor patients’ health, enabling swift responses to emerging complications through community-based interventions.
In a 2020 pilot study involving 20 patients using CirrhoCare and 20 controls receiving standard care, hospital readmissions decreased by 38% over an average of 10 weeks. Additionally, outpatient resource requirements, such as fluid drainage, saw an 80% reduction. Published in the Journal of Hepatology, these findings prompted a new randomized controlled trial.
The trial, backed by approximately £2 million in funding from the UK’s National Institute for Health and Care Research (NIHR), will encompass at least 12 NHS trusts and involve over 200 patients randomly assigned to either CirrhoCare or standard care.
Professor Raj Mookerjee, Chief Investigator of the trial and affiliated with the UCL Division of Medicine and Royal Free Hospital, London, highlighted the limitations of current care for advanced cirrhosis patients, emphasizing the reactivity of scheduled appointments every couple of weeks. Professor Mookerjee, further indicated that the identifications of patients requiring treatment occurs when they are not well and need emergency admission.
“This novel approach using CirrhoCare seeks to elicit signs of early deterioration so that patients needing treatment can receive prompt community-based intervention, so that further hospitalisations can ideally be prevented. In those with more severe deterioration, they can be prioritised for early hospital review, to offset emergency presentations.
“Deaths from liver disease have quadrupled since 1970 and are still increasing year on year. Liver disease is the third most common cause of premature death. However, there is significant regional variation in specialist liver services, with a disproportionate number of deaths occurring in the north of England.
“If CirrhoCare is shown to be effective, it will help ensure equal access to care. Whatever your postcode, you could have access to this platform and a specialist clinician, with intendant liver health and economic benefits.
Professor Mookerjee added that the ethics and regulatory approvals that are needed have been obtained and they ready to move to the next step with patient recruitment.
Before departing the hospital, patients enrolled in the CirrhoCare trial will be equipped with a smartphone containing a SIM card, a smartwatch for continuous heart monitoring, digital blood pressure and temperature monitoring, and ‘smart’ scales capable of capturing weight and body fluid composition. Additionally, they will have access to an app designed to assess changes in cognitive function related to cirrhosis.
The provided kit will also track sleep patterns and physical activity, prompting patients to answer questions via the app regarding their well-being or fluid intake. Subsequently, the collected data undergoes analysis through algorithms that can alert the clinical team to potential complications. A patient dashboard facilitates a quick daily review by clinicians, triggered as needed, and the app allows for secure two-way communication between patients and clinicians.
Pamela Everett, a 71-year-old resident of Holborn, whose cirrhosis stems from non-alcoholic fatty liver disease, participated in the initial trial. Reflecting on her experience, she indicated that she discovered I had fatty liver disease through a routine blood test. Initially, I felt okay, but as time passed, I began to feel worse, leading to my participation in the trial. I must say it was incredibly helpful, providing me with peace of mind as I felt monitored around the clock. She stated that she received a couple of phone calls during the trial when they noticed her blood pressure was quite low, and they discussed it.
