How a new app could reduce the risk of hospital readmission for patients with cirrhosis

Large-scale testing will begin this week of a new smartphone-based management system designed to improve care for patients with severe liver disease after hospital discharge.

These patients are now at particularly high risk of serious illness: 37 percent of patients with advanced cirrhosis (scarring of the liver) are readmitted to the hospital with complications within a month.

The system, known as CirrhoCare, aims to improve healthcare through an app connected to smart devices that reports any symptoms.

This allows doctors to remotely monitor patients’ health so they can respond quickly if complications arise.

A 2020 pilot study of 20 patients who used the app as well as 20 “control patients” who received standard care found that CirrhoCare reduced hospital readmissions by 38 percent over an average of 10 weeks.

The new study is much larger and includes more than 200 patients. The goal is to validate the app’s effectiveness and potentially pave the way for wider use of the app in healthcare.

“Currently, care for patients with advanced cirrhosis discharged from hospital is limited to routine visits every few weeks and is entirely reactive. “It turns out that people only need treatment if they feel very unwell and need to go to the emergency department,” said Professor Raj Mukherjee from University College London.

“This new approach with CirrhoCare aims to identify signs of early deterioration so that patients in need of treatment receive rapid community-based intervention, ideally preventing further hospitalization.” to respond to emergencies,” he said.

Before leaving the hospital, patients receive a smartphone with a SIM card, as well as a smart watch for heart monitoring, digital blood pressure and temperature, and a smart scale to measure weight and body fluids. They also have access to an app that can detect changes in a patient’s cognitive abilities.

The kit also tracks sleep patterns and physical activity, and monitors patients by regularly asking questions via the app, such as how they are feeling or how much fluid they have drunk.

The data is then analyzed by algorithms that alert doctors if complications occur. The patient dashboard allows physicians to perform quick daily assessments if desired, and the app allows for secure two-way communication between patient and physician.

Pamela Everett, 71, from Holborn: whose liver cirrhosis is caused by non-alcoholic fatty liver disease, took part in the first study.

“I only found out that I have a fatty liver thanks to a routine blood test. I was fine at first, but over time I got worse and that’s when I was taken to court,” she said.

“I must say I found this very helpful as it gave me peace of mind as I felt I was looked after 24/7. During the study they called me several times because they noticed that my blood pressure was quite low, so we discussed it.

“The monitoring also confirmed that I was getting enough sleep, which surprised me because I thought I wasn’t. It has also made me pay more attention to my diet because my weight goes up and down a bit. Honestly, I still loved using it and was really sad when it came time to give it back.”

The number of deaths from liver disease has quadrupled since 1970 and continues to rise every year. This makes liver disease the third most common cause of premature death.

However, Professor Mukherjee notes that “there are significant regional differences in specialist delivery services, with a disproportionate number of deaths occurring in the north of England.”

“If CirrhoCare is effective, it will help ensure equal access to health care. Regardless of your postcode, you can access this platform and specialist, which will bring significant benefits to liver health and the economy,” he said.

The £2 million project is funded by the UK’s National Institute for Health and Care Research (NIHR) and will be carried out across at least twelve NHS trusts, starting with the Royal Free Hospital in London.

Other hospitals include St George’s Hospital in London, Derriford Hospital in Plymouth, King’s College Hospital, Royal Liverpool Hospital, Queens Medical Center in Nottingham and the John Radcliffe Hospital in Oxford.

Researchers will begin recruiting participants for the study this week and later test new care management apps.

Vanessa Hebditch, director of communications and policy at the British Liver Trust, welcomed the process.

“The diagnosis of advanced liver disease can be a very worrying and confusing time for patients and their families.

“Once diagnosed with cirrhosis in hospital, patients are often unsure of what to expect and worry about continuity of care after leaving hospital.

That’s why it’s so important that patients and their families have access to preventive care that helps them cope with the complexities of their condition and gives them peace of mind and confidence.”