How to reduce liver disease deaths

With more than 6 million Australians suffering from serious liver disease, and the national death rate rising, new research at Flinders is calling for some simple steps to improve outcomes.

The study by Flinders University, Flinders Medical Centre (FMC) and SA Health researchers shows that patients managed under a chronic liver failure program supervised by liver specialists within a coordinated care model had a 48% lower rate of liver-related emergency readmissions and significantly improved (67.7% versus 37.2 %, p=0.009) three-year survival than patients managed with standard care.

Not being managed in the hospital with a coordinated care model was independently associated with a 2.5-fold higher risk of mortality.

Cirrhosis is a very serious and complex form of liver disease which is often not well managed, the researchers say in the latest issue of the Medical Journal of Australia.

“We argue that some simple measures can greatly improve outcomes for this chronic condition, which sometimes is poorly understood and mismanaged by patients and their medical and nursing systems,” says senior author Dr Alan Wigg, from FMC and the Flinders University College of Medicine and Public Health.

“We would like to expand this research to a multicentre trial to shore up some of the results we’ve shown in fewer liver-related emergency department and fatalities over a three-year period,” Dr Wigg says.

“Further research on liver disease, including cirrhosis, could help patients to lead better lives and present less frequently for emergency treatment at our hospitals.”

In the study, patients with decompensated cirrhosis under standard care at one hospital were compared with similar patients admitted at a second hospital, where their treatment was customised more closely to their condition.

Co-ordinated care models, which are a standard of care in conditions such as congestive heart failure, have not been well studied in patients with decompensated cirrhosis.

The retrospective cohort study in South Australia has suggested benefits of closer monitoring of cirrhosis patients after emergency or hospital admission, with continuity of care coordinated by liver specialists and liver nurses during and after hospital admissions.

The current study builds on the group’s earlier pilot randomised trial in 2013-14, which was based at FMC (see references below). In this study benefits were associated with the coordinated care model including; significantly improved quality of care, patient attendance at clinic visits and cost effectiveness.

Trends towards lower mortality and improved hospital utilisation were also observed.

Alcohol, hepatitis C and non-alcoholic steatohepatitis or fatty liver disease are the main causes of liver disease.

The article, ‘Coordinated care for patients with cirrhosis: fewer liver-related emergency admissions and improved survival,’ by J Ramachandran, M Hossain, C Hrycek, E Tse, KR Muller, RJ Woodman, B Kaambwa and AJ Wigg, appears in this month’s MJA, published by the Medical Journal of Australia.

Papers from the previous study –

Wigg AJ, McCormick R, Wundke R, Woodman RJ. Efficacy of a chronic disease management model for patients with chronic liver failure (2013). Clinical Gastroenterology and Hepatology Jul;11(7):850-8.

Wigg AJ, Chin JK, Muller K., Ramachandran J, Woodman RJ and Kaambwa BC (2018). A Chronic Disease Management Model for Cirrhosis is Cost-Effective: Analysis of a Randomised Controlled Trial. Journal of Gastroenterology and Hepatology, 33(February) pp. 1634-1640.

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