Monitoring for Ascites in Cirrhosis Using Patient-Generated Health Data: No Longer a Remote Possibility

Abstract

Cirrhosis is a chronic condition with a well-documented high symptom burden, morbidity, mortality and costs [1][2][3]. Asrani et al. reported that in-hospital mortality from cirrhosis exceeds that from other serious comorbidities such as congestive heart failure or chronic obstructive pulmonary disease [1]. Ascites is a particularly common and costly cirrhosis complication that has been the target of several interventions aimed to reduce hospitalization frequency and length by improving timely access to paracentesis and redesigning acute models of care [4,5]. Though telemedicine and "automated hovering" interventions are particularly promising modalities that can improve access to care and inbetween visit monitoring, the evidence base for their clinical effectiveness and optimal implementation is still building for cirrhosis [6,7].In this issue of Digestive Diseases and Sciences, Bloom et al. evaluated the costs and outcomes of a telemonitoring intervention for ascites in cirrhosis [8]. The authors developed a decision-analytic model that examined payerperspective costs of a standard-of-care compared with a telemonitoring intervention among 100 simulated patients at a tertiary care center over a 6-month horizon. The model was based on the premise of an initial hospital admission for tense ascites. Model assumptions were straightforward: the standard-of-care model assumed a rehospitalization for gradually reaccumulated ascites after the index * Marina Serper

Redefining Success After Liver Transplantation: From Mortality Toward Function and Fulfillment

“…(72) Transplant center resources are then tailored and deployed based on the nature of issue identified; this strategy is now being tested in a prospective trial among kidney transplant recipients (NCT03104868) and can be further developed for LTRs. The recent rapid uptake of digital health tools and telemedicine (73)(74)(75) can be leveraged to deploy remote patient monitoring. A recent pilot trial showed that a remote monitoring intervention after LT reduced 90-day readmissions and improved quality of life.…”