Evaluation of CirrhoCare? - a digital health solution for home management of individuals with cirrhosis

Background & Aims: Individuals with cirrhosis 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 individuals with acutely decompensated cirrhosis using CirrhoCare (R). Methods: Individuals with cirrhosis with acute decompensation were followed up with CirrhoCare (R) and compared with contemporaneous matched controls, managed with standard follow-up. Commercially available monitoring devices were linked to the smartphone CirrhoCare (R) app, for daily recording of heart rate, blood pressure, weight, % body water, cognitive function (CyberLiver 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 the appropriateness of CirrhoCare (R) - based decisions. Results: Twenty individuals with cirrhosis were recruited to CirrhoCare (R) (mean age 59 +/- 10 years, 14 male, alcohol-related cirrhosis [80%], mean model for end-stage liver disease-sodium [MELD-Na] score 16.1 +/- 4.2) and were not statistically different to 20 contemporaneous controls. Follow-up was 10.1 +/- 2.4 weeks. Fifteen individuals 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 (R)-managed individuals had 8 readmissions over a median of 5 (IQR 3.5-11) days, and none required hospitalisation for >14 days. Sixteen other CirrhoCare (R)-guided patient contacts were made, leading to clinical interventions that prevented further progression. Appropriateness was confirmed by adjudicators. Controls had 13 readmissions in 8 individuals, lasting a median of 7 (IQR 3-15) days with 4 admissions of >14 days. They had 6 unplanned paracenteses compared with 1 in the CirrhoCare (R) group. Conclusions: This study demonstrates that CirrhoCare (R) is feasible for community management of individuals with decompensated cirrhosis with good engagement and clinically relevant alerts to new decompensating events. CirrhoCare (R)-managed individuals have fewer and shorter readmissions justifying larger controlled clinical trials. (c) 2022 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.