Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis

Konstantin Kazankov; Simone Novelli; Devnandan A Chatterjee; Alexandra Phillips; Anu Balaji; Maruthi Raja; Graham Foster; Dhiraj Tripathi; Ravan Boddu; Ravi Kumar; Rajiv Jalan; Rajeshwar P Mookerjee

doi:10.1016/j.jhep.2022.08.034

Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis

Konstantin Kazankov, Simone Novelli, Devnandan A Chatterjee, Alexandra Phillips, Anu Balaji, Maruthi Raja, Graham Foster, Dhiraj Tripathi, Ravan Boddu, Ravi Kumar, Rajiv Jalan, Rajeshwar P Mookerjee^*

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin - Lever-, Mave- og Tarmsygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

15 Citationer (Scopus)

Abstract

BACKGROUND: Cirrhosis patients 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 acutely decompensated cirrhosis patients using CirrhoCare®.

METHODS: Cirrhosis patients with acute decompensation were followed 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 [CL-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 appropriateness of CirrhoCare-based decisions.

RESULTS: Twenty-cirrhotic patients were recruited to CirrhoCare® (mean age 59±10 years, 14-male, alcoholic cirrhosis (80%), mean MELD-Na score 16.1±4.2) and were not statistically different to twenty contemporaneous controls. Follow up was 10.1±2.4 weeks. Fifteen-patients 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 patients had 8-readmissions over median of 5 (IQR 3.5-11) days, and none required hospitalization 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-patients, lasting median 7 (IQR 3-15) days with 4-admissions of >14 days. They had 6 unplanned paracenteses compared to 1 in the CirrhoCare® group.

CONCLUSIONS: This study demonstrates CirrhoCare® is feasible for community management of decompensated cirrhosis patients with good engagement and clinically-relevant alerts to new decompensating events. CirrhoCare® managed patients have fewer and shorter readmissions justifying confirmatory larger controlled clinical trials.

LAY SUMMARY: This first study of digital, real-time, home management for multiple complications of advanced cirrhosis, with CirrhoCare®, showed positive patient engagement and feedback in patients with mainly alcohol-related cirrhosis, following a recent hospital discharge. CirrhoCare® allowed early diagnosis of new complications for patients at home, prompting their hepatologists to intervene over >10 weeks follow-up. CirrhoCare® managed patients had fewer and shorter hospital readmissions, as well as less unplanned abdominal fluid drains than in a control group. CirrhoCare® is a promising tool for specialist, community management of cirrhosis patients, at-risk of new cirrhosis complications.

Originalsprog	Engelsk
Tidsskrift	Journal of Hepatology
Vol/bind	78
Nummer	1
Sider (fra-til)	123-132
Antal sider	10
ISSN	0168-8278
DOI	https://doi.org/10.1016/j.jhep.2022.08.034
Status	Udgivet - jan. 2023

Adgang til dokumentet

10.1016/j.jhep.2022.08.034

Citationsformater

@article{695a8d475de14a5ca43bf40d50991d1b,

title = "Evaluation of CirrhoCare{\textregistered} – a digital health solution for home management of individuals with cirrhosis",

abstract = "BACKGROUND: Cirrhosis patients 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 acutely decompensated cirrhosis patients using CirrhoCare{\textregistered}.METHODS: Cirrhosis patients with acute decompensation were followed with CirrhoCare{\textregistered} and compared with contemporaneous matched controls, managed with standard follow-up. Commercially available monitoring devices were linked to the smartphone CirrhoCare{\textregistered}-App, for daily recording of heart rate, blood pressure, weight, % body-water, cognitive function [CL-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 appropriateness of CirrhoCare-based decisions.RESULTS: Twenty-cirrhotic patients were recruited to CirrhoCare{\textregistered} (mean age 59±10 years, 14-male, alcoholic cirrhosis (80%), mean MELD-Na score 16.1±4.2) and were not statistically different to twenty contemporaneous controls. Follow up was 10.1±2.4 weeks. Fifteen-patients 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{\textregistered}-managed patients had 8-readmissions over median of 5 (IQR 3.5-11) days, and none required hospitalization 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-patients, lasting median 7 (IQR 3-15) days with 4-admissions of >14 days. They had 6 unplanned paracenteses compared to 1 in the CirrhoCare{\textregistered} group.CONCLUSIONS: This study demonstrates CirrhoCare{\textregistered} is feasible for community management of decompensated cirrhosis patients with good engagement and clinically-relevant alerts to new decompensating events. CirrhoCare{\textregistered} managed patients have fewer and shorter readmissions justifying confirmatory larger controlled clinical trials.LAY SUMMARY: This first study of digital, real-time, home management for multiple complications of advanced cirrhosis, with CirrhoCare{\textregistered}, showed positive patient engagement and feedback in patients with mainly alcohol-related cirrhosis, following a recent hospital discharge. CirrhoCare{\textregistered} allowed early diagnosis of new complications for patients at home, prompting their hepatologists to intervene over >10 weeks follow-up. CirrhoCare{\textregistered} managed patients had fewer and shorter hospital readmissions, as well as less unplanned abdominal fluid drains than in a control group. CirrhoCare{\textregistered} is a promising tool for specialist, community management of cirrhosis patients, at-risk of new cirrhosis complications.",

keywords = "Decompensation, Liver disease, Remote management",

author = "Konstantin Kazankov and Simone Novelli and Chatterjee, {Devnandan A} and Alexandra Phillips and Anu Balaji and Maruthi Raja and Graham Foster and Dhiraj Tripathi and Ravan Boddu and Ravi Kumar and Rajiv Jalan and Mookerjee, {Rajeshwar P}",

year = "2023",

month = jan,

doi = "10.1016/j.jhep.2022.08.034",

language = "English",

volume = "78",

pages = "123--132",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier B.V.",

number = "1",

}

Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis. / Kazankov, Konstantin; Novelli, Simone; Chatterjee, Devnandan A et al.
I: Journal of Hepatology, Bind 78, Nr. 1, 01.2023, s. 123-132.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis

AU - Kazankov, Konstantin

AU - Novelli, Simone

AU - Chatterjee, Devnandan A

AU - Phillips, Alexandra

AU - Balaji, Anu

AU - Raja, Maruthi

AU - Foster, Graham

AU - Tripathi, Dhiraj

AU - Boddu, Ravan

AU - Kumar, Ravi

AU - Jalan, Rajiv

AU - Mookerjee, Rajeshwar P

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND: Cirrhosis patients 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 acutely decompensated cirrhosis patients using CirrhoCare®.METHODS: Cirrhosis patients with acute decompensation were followed 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 [CL-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 appropriateness of CirrhoCare-based decisions.RESULTS: Twenty-cirrhotic patients were recruited to CirrhoCare® (mean age 59±10 years, 14-male, alcoholic cirrhosis (80%), mean MELD-Na score 16.1±4.2) and were not statistically different to twenty contemporaneous controls. Follow up was 10.1±2.4 weeks. Fifteen-patients 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 patients had 8-readmissions over median of 5 (IQR 3.5-11) days, and none required hospitalization 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-patients, lasting median 7 (IQR 3-15) days with 4-admissions of >14 days. They had 6 unplanned paracenteses compared to 1 in the CirrhoCare® group.CONCLUSIONS: This study demonstrates CirrhoCare® is feasible for community management of decompensated cirrhosis patients with good engagement and clinically-relevant alerts to new decompensating events. CirrhoCare® managed patients have fewer and shorter readmissions justifying confirmatory larger controlled clinical trials.LAY SUMMARY: This first study of digital, real-time, home management for multiple complications of advanced cirrhosis, with CirrhoCare®, showed positive patient engagement and feedback in patients with mainly alcohol-related cirrhosis, following a recent hospital discharge. CirrhoCare® allowed early diagnosis of new complications for patients at home, prompting their hepatologists to intervene over >10 weeks follow-up. CirrhoCare® managed patients had fewer and shorter hospital readmissions, as well as less unplanned abdominal fluid drains than in a control group. CirrhoCare® is a promising tool for specialist, community management of cirrhosis patients, at-risk of new cirrhosis complications.

AB - BACKGROUND: Cirrhosis patients 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 acutely decompensated cirrhosis patients using CirrhoCare®.METHODS: Cirrhosis patients with acute decompensation were followed 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 [CL-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 appropriateness of CirrhoCare-based decisions.RESULTS: Twenty-cirrhotic patients were recruited to CirrhoCare® (mean age 59±10 years, 14-male, alcoholic cirrhosis (80%), mean MELD-Na score 16.1±4.2) and were not statistically different to twenty contemporaneous controls. Follow up was 10.1±2.4 weeks. Fifteen-patients 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 patients had 8-readmissions over median of 5 (IQR 3.5-11) days, and none required hospitalization 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-patients, lasting median 7 (IQR 3-15) days with 4-admissions of >14 days. They had 6 unplanned paracenteses compared to 1 in the CirrhoCare® group.CONCLUSIONS: This study demonstrates CirrhoCare® is feasible for community management of decompensated cirrhosis patients with good engagement and clinically-relevant alerts to new decompensating events. CirrhoCare® managed patients have fewer and shorter readmissions justifying confirmatory larger controlled clinical trials.LAY SUMMARY: This first study of digital, real-time, home management for multiple complications of advanced cirrhosis, with CirrhoCare®, showed positive patient engagement and feedback in patients with mainly alcohol-related cirrhosis, following a recent hospital discharge. CirrhoCare® allowed early diagnosis of new complications for patients at home, prompting their hepatologists to intervene over >10 weeks follow-up. CirrhoCare® managed patients had fewer and shorter hospital readmissions, as well as less unplanned abdominal fluid drains than in a control group. CirrhoCare® is a promising tool for specialist, community management of cirrhosis patients, at-risk of new cirrhosis complications.

KW - Decompensation

KW - Liver disease

KW - Remote management

U2 - 10.1016/j.jhep.2022.08.034

DO - 10.1016/j.jhep.2022.08.034

M3 - Journal article

C2 - 36087864

SN - 0168-8278

VL - 78

SP - 123

EP - 132

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 1

ER -

Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis

Abstract

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