Editorial: Timely Follow-Up in Cirrhosis: How Does It Work?

Abstract

Cirrhosis is a debilitating disease with substantial impact on health and prognosis. As the early stages of cirrhosis are asymptomatic or associated with non-specific symptoms, it was previously often diagnosed late in the disease course, after the development complications [1]. New biomarkers, liver scores and elastography have advanced noninvasive diagnosis, and the incidence and prevalence of cirrhosis are increasing [2]. Apart from liver transplantation and treatment of viral hepatitis, there is no recommended therapy for cirrhosis. However, effective interventions are available for cirrhosis-related complications, so timely outpatient follow up and care may improve patient outcomes.

Schechter and colleagues have published a registry study assessing the impact of follow-up after the diagnosis of cirrhosis. The cumulative incidence of patients with follow-up within 90 days was 42.7%, and mortality and rehospitalization rates were reduced. Patients who did not receive follow-up within 90 days, were more likely to have alcohol use disorder and a considerable proportion were re-hospitalised or died within 90 days of diagnosis. Patients who received follow-up, had less cardiovascular disease, lower rates of diabetes and a lower baseline health care utilisation rate [3].

Although limited by the lack of data from the primary sector and general practice visits, Schechter and colleagues establish the importance of follow-up in cirrhosis, as follow-up is becoming more frequent in every-day clinical practice.

The registry-based design does not reveal content, context, or clinical relevance of the follow-up. Prior studies have assessed various types and formats of follow-up for patients with liver disease [4, 5]. The natural course of cirrhosis varies with aetiology, severity and comorbidities, which is adjustable in registry-based studies. However, family network, frailty and social factors may also impact the prognosis of liver cirrhosis [6]. Better understanding of these factors may support the planning, the focus and content of the timely follow-up, to improve survival, prevent complications, unnecessary admissions to the hospital and loss of functions and quality of life in patients with liver cirrhosis.

An important finding of the study by Schechter and colleagues was that in unadjusted analyses, patients who received follow-up within 90 days were more likely to be younger, have fewer comorbidities, and have over 12 years of education [3]. Higher education is often linked to better health literacy, enabling patients to navigate the healthcare system and understand medical advice better. The findings, although not significant in adjusted analyses, suggest a risk of unequal access to follow-up care of those with fewer resources. To address this disparity, healthcare systems should implement strategies to support underserved populations. Studies suggest that comorbidities and provider-patient communication play an important role in adherence to follow-up [7].

Research is needed to identify the most effective follow-up strategies, understand barriers to care, and explore interventions that enhance patient adherence. Future research should focus on optimising care coordination, timely follow-up with a personalised approach, taking severity and stage of cirrhosis into account. A stronger focus on the quality of the follow-up, and evaluation of the reach, dose and fidelity of the follow-up interventions may support clinical decision-making for in the future.

Nina Kimer: conceptualization, writing – original draft, writing – review and editing. Lise Lotte Gluud: conceptualization, writing – original draft, writing – review and editing.

The authors declare no conflicts of interest.

This article is linked to Schechter et al papers. To view these articles, visit https://doi.org/10.1111/apt.18309 and https://doi.org/10.1111/apt.18365 and https://doi.org/10.1111/apt.18376.