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

A new smartphone-based management system to improve the care of patients with severe liver disease after they are discharged from hospital will begin a major trial this week.

These patients face a particularly high risk of severe ill health at this point, with 37 per cent of those with advanced cirrhosis – scarring of the liver – being re-admitted to hospital within a month with complications.

The system, known as CirrhoCare, aims to improve their care through an app that is linked to smart devices that flag up any concerning symptoms.

It enables doctors to monitor patients’ health remotely, so that they can respond quickly if complications arise.

A pilot study in 2020, looking at 20 patients using the app alongside 20 “controls” receiving standard care, found that CirrhoCare reduced hospital readmissions by 38 per cent over an average of 10 weeks.

The new trial is much bigger, involving more than 200 patients, and will aim to confirm the app’s effectiveness, potentially paving the way for the app to be used more widely in the healthcare service.

“Current care for advanced cirrhosis patients being discharged from hospital is limited to scheduled appointments every couple of weeks and is entirely reactive. People are identified as needing treatment only when they are very unwell and require emergency admission,” said Professor Raj Mookerjee, of University College London.

“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,” he said.

Before leaving hospital, patients will be given a smartphone enabled with sim card, as well as a smartwatch that can monitor heart, digital blood pressure and temperature, and “smart” scales which can capture weight and body fluid composition. They will also have access to an app that can identify changes in the patient’s cognitive abilities.

The kit also records sleep patterns and physical activity, and will keep an eye on patients by asking regular questions through the app – such as how they feel or how much fluid they have drunk.

The data is then analysed by algorithms which will flag to the doctors if a complication may be occurring. A patient dashboard enables a quick, daily review by clinicians if prompted, and the app allows for two-way, secure communication between patient and clinician.

Pamela Everett, 71, from Holborn: whose cirrhosis is as a result of non-alcoholic fatty liver disease, took part in the initial trial.

“I only found out I had fatty liver disease after a routine blood test. I felt OK to begin with but progressively I felt worse and that’s when I was put on the trial,” she said.

“I have to say I found it really helpful, as it gave me peace of mind as I felt like I was being looked after 24/7. I did get a couple of phone calls during the trial because they noticed my blood pressure was quite low so we discussed that.

“The monitoring also reassured me I was getting plenty of sleep, which I was surprised about as I thought I wasn’t, and it also made me more mindful about what I was eating as my weight does go up and down a bit. To be honest I’d have happily carried on using it and I felt quite sad when it was time to give it back.”

Deaths from liver disease have quadrupled since 1970 and are still increasing year on year, making it the third most common cause of premature death.

However, Professor Mookerjee points out that “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,” he said.

The £2m project is being funded by the UK’s National Institute for Health and Care Research (NIHR), will be carried out in at least 12 NHS trusts, starting with the Royal Free Hospital, London.

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

The researchers will start recruiting participants for the trial this week before testing the new care management apps a bit further down the line.

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

“Being diagnosed with an advanced form of liver disease can be a deeply worrying and confusing time for patients and their loved ones.

“After receiving a cirrhosis diagnosis in the hospital, patients often feel uncertain about what lies ahead and worry about the continuity of care once they leave.

That’s why it’s vital for patients and their families to have access to proactive care, helping them navigate the complexities of their condition and providing peace of mind and reassurance.”