Biometric data is key in managing chronic liver disease and cirrhosis. Remote health technologies can be used to track biometric data and serve as an early warning system for complications in liver disease patients. This article discusses remote patient monitoring for cirrhosis and describes current research into patient satisfaction, reduced hospital readmissions, and quality of life using remote monitoring for cirrhosis.
Cirrhosis Facts
Cirrhosis is severe scarring of the liver caused by various liver diseases. It affects 4.5 million U.S. adults. Liver damage caused by cirrhosis generally can’t be undone. However, if liver cirrhosis is diagnosed early and the underlying cause is treated, further damage may be limited.
Cirrhosis often has no symptoms until liver damage is severe. When symptoms do occur, they may include:
- Jaundice of the eyes
- Ascities: fluid accumulation in the abdomenFatigue
- Easily bleeding or bruising
- Loss of appetite.
- Nausea
- Edema: Swelling in the legs, feet or ankles
- Weight loss
- Itchy skin
The readmission rate for patients with cirrhosis discharged from the hospital is about 50%, leading researchers to report that current outpatient monitoring strategies are inadequate. A study of the costs of care for patients with cirrhosis compared 39,361 cirrhosis patients to 138,964 controls. The adjusted incremental cost for cirrhosis care was $35,029 in the first year, decreasing to $14,216-$17,629 annually over the next three years.
The following sections explain how remote patient monitoring for cirrhosis can help by identifying problems early on, reducing hospital readmissions, improving patient satisfaction, and reducing medical costs.
Research in Remote Patient Monitoring for Cirrhosis
Research reports that telemedicine is a useful tool in monitoring fatty liver disease and cirrhosis. Remote patient monitoring can track symptoms such as ascites and encephalopathy. Monitoring cirrhosis symptoms such as increases in body weight and health data like body temperature, and heart rate prevents rehospitalizations and has an impact on lower financial costs.
Beyond cost savings remote monitoring can detect increases in symptoms, and help prevent hospital readmissions, and limited access to therapies, which are associated with poor quality of life.
A new study examined the implementation and impact of a cirrhosis-specific remote patient monitoring program called CiRPM. The program tracked 41 patients with decompensated cirrhosis over an average of 83.9 days. It allowed for remote management of hepatic encephalopathy and ascites.
Results of the study showed:
- Participants uploaded vital signs answers to questionnaires on 93% of monitored days.
- 88% of participants had high utilization (completing tasks on ≥85% of days).
- Over 75% of surveyed patients expressed satisfaction with the program.
- The 90-day readmission rate was 34% in CiRPM vs 47% in weighted controls.
- 12% of CiRPM subjects had 2+ readmissions, compared to 37% in controls.
- Potentially preventable readmissions were 36% in CiRPM vs 57% in controls.
While the study showed trends toward reduced readmissions and mortality in the CiRPM group, it did not reach statistical significance. The researchers conclude that cirrhosis monitoring with RPM is feasible and well-accepted by patients, but larger studies are needed to confirm its impact on outcomes.
New Remote Health Technologies for Monitoring Cirrohsis
CirrhoCare is a remote monitoring cirrhosis tool used for out-of-hospital specialist hepatology follow-up and intervention of adult cirrhosis patients who are at risk of acute cirrhosis decompensation. A 2023 study from University College London published in the Journal of Hepatology has highlighted the potential of digital therapeutics in monitoring and managing patients with cirrhosis. It evaluated the then-new monitoring system called CirrhoCare.
CirrhoCare tracks various metrics including weight, water and alcohol intake, cognitive function, and overall well-being with remote monitoring. It’s the first system of its kind to assess multiple key complications of cirrhosis decompensation events. The study involved 20 cirrhosis patients, mostly with alcoholic cirrhosis, matched with 20 controls. Over a follow-up period of about 10 weeks, the researchers found that 15 out of 20 patients engaged with the app at least four times per week.
The patients using CirrhoCare experienced fewer hospital readmissions, and when readmissions did occur, they tended to be shorter and happen more quickly. Five patients had eight readmissions with a median stay of five days, and none lasted more than two weeks.
In contrast, the control group saw 13 readmissions among eight patients, four of which lasted over two weeks. Clinicians also made 16 contacts with patients based on CirrhoCare data, potentially limiting patient deterioration. Additionally, the CirrhoCare group had only one unplanned paracentesis compared to six in the control group.
Understanding Monitoring for Cirrhosis with Remote Healthcare
Cirrhosis remains a considerable concern for morbidity and healthcare expenditure. Telemedicine technologies are useful tools to prevent liver decompensation and hospitalization, lower healthcare costs and increase access to care for patients with limited resources.
RPM technologies can track critical biometric data and symptoms like ascites and encephalopathy, serving as an early warning system for complications.
Furthermore, remote technologies like wearables and apps are even assessing and seeking to improve the cognitive state of cirrhosis patients. Moreover, reducing worsening of symptoms also likely increases the overall quality of life in patients with liver disease. As telemedicine continues to evolve, it may play an increasingly important role in preventing liver decompensation and managing this chronic condition more effectively.
