Background Ascites is a common, painful, and serious complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. Objective This study aims to evaluate the feasibility of a smartphone app in facilitating outpatient ascites management. Methods In this feasibility study, patients with cirrhotic ascites requiring active management were identified in both inpatient and outpatient settings. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a smartphone app and then via the internet to an electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change of ≥5 lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were the percentage of enrolled days during which weight data were successfully transmitted to an EMR and the percentage of weight alerts that prompted responses by the provider. Results In this study, 25 patients were enrolled: 12 (48%) were male, and the mean age was 58 (SD 13; range 35-81) years. A total of 18 (72%) inpatients were enrolled. Weight data were successfully transmitted to an EMR during 71.2% (697/979) of the study enrollment days, with technology issues reported on 16.5% (162/979) of the days. Of a total of 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) were by weight gain. Providers responded in some fashion to 66 (84%) of the weight alerts and intervened in response to 45 (57%) of the alerts, for example, by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose, or requesting a laboratory workup. Providers responded equally to weight increase and decrease alerts (P=.87). The staff called patients a mean of 3.7 (SD 3.5) times per patient, and the number of phone calls correlated with technology issues (r=0.60; P=.002). A total of 60% (15/25) of the patients chose to extend their participation beyond 30 days. A total of 17 patient readmissions occurred during the study period, with only 4 (24%) related to ascites. Conclusions We demonstrated the feasibility of a smartphone app to facilitate the management of ascites and reported excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among patients with cirrhosis.

BackgroundTechnology represents a promising tool to improve healthcare delivery for patients with cirrhosis. We sought to assess utilisation of technology and preferred features of a digital health management tool, in patients with an early readmission for decompensated cirrhosis.MethodsWe conducted a cross-sectional study of patients readmitted within 90 days for decompensated cirrhosis. A semistructured interview obtained quantitative and qualitative data through open-ended questions.ResultsOf the 50 participants, mean age was 57.6 years and mean (range) model for end stage liver disease was 22.7 (10–46). Thirty-eight (76%) patients own a Smartphone and 62% have regular access to a computer with internet. Thirty-nine (78%) patients would consider using a Smartphone application to manage their cirrhosis. Forty-six (92%) patients report having a principal caregiver, of which 80% own a Smartphone. Patients were interested in a Smartphone application that could communicate with their physician (85%), send medication notifications to the patient (65%) and caregiver (64%), transmit diagnostic results and appointment reminders (82%), educate about liver disease (79%), regularly transmit weight data to the doctor (85% with ascites) and play a game to detect cognitive decline (67% with encephalopathy). Common themes from qualitative data include a desire to learn about liver disease and communicate with providers via digital tools.ConclusionAmong patients with cirrhosis with an early readmission for decompensation, most have Smartphones and would be willing to use a Smartphone to manage their disease. Future digital health management tools should be tailored to the use patterns and preferences of the patients with cirrhosis and their caregivers.

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Background Ascites, or accumulation of abdominal free fluid, develops in two-thirds of patients with cirrhosis. Ascites is painful and, if inadequately managed, can lead to life-threatening complications, including spontaneous bacterial peritonitis and kidney failure. Body weight is an effective proxy for ascites volume; therefore, monitoring daily weights is recommended for optimal ascites management. At present, patients with ascites rarely proactively alert providers of significant weight gains, and there are no widely available technologies specifically designed for ascites monitoring. Objective The objective of this pilot study is to assess the feasibility of a smartphone app to manage outpatient ascites. Methods In this feasibility study, cirrhotic patients with significant ascites requiring specialist management are identified through an inpatient hepatology consult census and outpatient referrals. Each candidate is sent home with a Bluetooth-connected scale, which transmits weight data to the PGHD Connect Smartphone App, and then via the cloud into the electronic medical record (EMR). Weights are monitored every weekday by study staff and alerts are sent to providers if their patients’ weight changes by ≥5lbs within a week or from the weight documented at discharge. The primary outcomes are percentage of study enrollment days when weight data was successfully transmitted into the EMR and percentage of weight alerts to which providers responded. Results Seventy-eight cirrhotic patients were identified as requiring active management of ascites. Of these patients, 8 did not own a smartphone, 23 were encephalopathic, and thus were excluded; another 1 declined to participate, and 3 were consented but subsequently withdrawn due to physical limitation or death prior to hospital discharge. Each patient is enrolled in the program for 28 days. Of the 16 patients currently enrolled, 5 (31%) are male, mean age is 60.9 years (SD 11.1), 13 (81%) were enrolled as inpatients, 8 (50%) have non-alcoholic steatohepatitis cirrhosis, 4 (25%) alcohol-associated cirrhosis, and 2 (12.5%) viral cirrhosis. At this interim analysis, transmission of weight data into the EMR has successfully occurred on 70% of study enrollment days. Patients experienced technology issues during 10% of days enrolled. Of the total 20 weight alerts to date, 12 (60%) were triggered by weight loss ≥5lb in one week, 7 (35%) by weight gain ≥5lb in one week, and 1 (5%) by weight gain ≥5lb since discharge. Providers responded to 13 (65%) of the weight alerts within 24 hours. Of the 13 alerts with a provider response, 7 (54%) were followed by a call or email to the patient to discuss care, 4 (31%) a scheduled appointment, 4 (31%) a change in diuretic dosage, 3 (23%) scheduling for paracentesis (procedure to remove ascites fluid), and 3 (23%) further laboratory workup. To date, there have been 13 readmissions. Conclusions On the basis of our interim analysis, we demonstrate feasibility of a martphone app to facilitate ascites management. We report encouraging rates of patient and provider engagement. This innovation shows promise in enabling early intervention and enhancing quality of life in cirrhotic patients. Future studies will investigate the efficacy of mobile health technology to improve outcomes in this population.

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