Cirrhosis Remote Care Management impacted by COVID-19

The COVID-19 pandemic has necessitated an unusual allocation of healthcare resources which inevitably, negatively impacts on resources available to care for patients with chronic diseases like cirrhosis (scarring of the liver in advanced disease), who still require high levels of medical oversight. Unlike many chronic diseases, cirrhosis mortality is increasing exponentially; it is the third cause of premature death in working-age people, with 62,000 years of working life lost/year, and NHS care costs >£3.5bn. In 2019, there were 73,669 UK hospital admissions from cirrhosis. 25% of all cirrhosis patients are at risk of needing acute treatment for complications such as fluid overload, confusion, kidney dysfunction, infections, and gastrointestinal bleeding. These patients require a regular clinical assessment and even when discharged following a recent hospital admission, have re-admission rates approaching 40% in 6 weeks. During the current pandemic, such patients have limited access to direct clinical review, and many avoid hospital for fear of infection. Invariably this has meant that many cirrhosis patients will not receive the level of care they need and will incur further morbidity and mortality, not currently captured by the reported Government COVID-19 statistics.

Our CirrhoCare project is addressing this clinical need through remote Digital monitoring of at-risk cirrhosis patients, using remotely acquired important vital signs such as heart rate and blood pressure, (using low cost, blue-tooth, low energy wearable technology), and assessment of higher mental function and weight (established smartphone app tools), all of which are key metrics that are perturbed as cirrhosis advances. By efficiently collating this data on CyberLiver Ltd.'s 'CirrhoCare' platform is improving the clinical workflow such that vital data is organised and presented to clinicians on a dashboard, to facilitate informed, remote 'consultations'. This will allow early detection of signs of cirrhosis complications in the community, and rapid triage of patients needing early direct clinical review, at a time when this is a limited resource. Our solution will prioritise care whilst limiting risk of COVID-19 exposure, and also personalising this to an individual patient's needs and disease, making it more acceptable and convenient for patients. In the long term, costs efficiencies will arise through more streamlined outpatient direct contacts, potentially applicable to a wider liver disease remit, and with scalable processes, whilst delivery costs will reduce further as this technology is more widely adopted, in a digitized NHS.