People with severe liver cirrhosis can spend a lot of time in hospital because of complications. Now researchers are looking at a new way to tackle this. Using technology at home to find problems sooner and manage these in the community.
Severe liver cirrhosis can cause a number of complications. These include a build up of fluid in the tummy (ascites), confusion and memory problems (hepatic encephalopathy), and an increased risk of infections. These complications often need to be treated in hospital.
But they can come back. Almost 4 in 10 people will be readmitted to hospital within 4 weeks. Many NHS liver services are struggling to manage this demand. Patients can face a post-code lottery when trying to get the care they need.
The recent CirrohCare trial looked at managing this problem in a new way. People with cirrhosis were given a smart phone linked to their hospital and to home monitoring devices. These devices looked for signs that cirrhosis could be getting worse.
The CirrohCare system
For people with a liver condition, the CirrohCare system is made up of a smart phone, a smart watch, smart blood pressure monitor, and a set of smart scales.
The watch measures heart rate and its variation. The smart scales check on weight and fluid balance. As well as automatically collecting this data, the smart phone has an app to check for any signs of confusion or brain fog. Patients can see all their data on the phone.
Doctors can also see all the data in real time. Using a secure dashboard on their hospital computer. The system uses algorithms to help the doctors. These pick up the signs of a problem and flag them for the doctor to look at.
Doctors can also send messages to people using the system. These can help them act before a complication becomes more serious. They can also change the treatment at home based on the signals on the dashboard.
Early results
The early trial had very positive results. Most people given the technology used it several times each week. So doctors were always able to check on how they were doing. Rather than waiting for a scheduled appointment or a sudden worsening of symptoms.
Spotting problems early meant that they could sometimes be treated more easily. For example by making changes to a medicine. Overall, those on the trial were less likely to need hospital treatment.
People taking part said that the system helped them feel less anxious. Knowing that they were being monitored was also reassuring. It helped them to feel more informed, and better prepared for possible complications.
This trial was funded by Innovate UK. It was overseen by Professor Raj Mookerjee, based at The Royal Free, London. The results were published in the Journal of Hepatology.
New trial
Professor Mookerjee is continuing to work with a UK company called Cyberliver, on a much larger trial. This has been funded by a large award from the National Institute for Health Research (NIHR). This will compare CirrohCare with the usual way that cirrhosis is managed. Looking at how well it performs for patients and how cost effective it is for hospitals.
12-15 hospitals across the UK will take part. The first four sites have already opened for recruiting people with cirrhosis. They are in Liverpool, the Royal Free and Kings College Hospitals in London, and Oxford.
People taking part in the trial will be randomly assigned to either the test group or the control group. The test group will use the CirrohCare system. The control group will receive the usual care for their condition. People in both groups will be followed for 12 weeks.
If the trial is successful, it is hoped that the new system could be helping people with cirrhosis across the UK within a few years.
If you have cirrhosis and you are interested in getting involved, talk to your hospital medical team to see if they are taking part.
The British Liver Trust are working with the research team. Ensuring that the patient perspective is included in the work.
