Letter: Timely Follow-Up in Cirrhosis—A Key Public Health Intervention

Editors,

We have carefully reviewed the recent article by Schechter et al. entitled ‘Association Between Timely Follow-Up After Initial Diagnosis of Cirrhosis and Reduced Mortality: A Nationwide Cohort Study of 8,852 Patients’ [1]. The study demonstrates a significant correlation between timely outpatient follow-up and reduced 1-year mortality in cirrhosis patients, offering important insights into the management of cirrhosis care. However, we believe there are areas where the study could be further enhanced.

First, the study spans nearly 19 years (from 1 January 2002 to 1 December 2020), a period during which the management and treatment strategies for cirrhosis have likely evolved. For instance, the widespread use of nonselective beta-blockers and the introduction of direct-acting antivirals (DAAs) have significantly improved cure rates for hepatitis C-related cirrhosis. Additionally, advancements in imaging technologies (such as ultrasound, CT, and MRI) have facilitated earlier detection of liver cancer and its complications. However, the article does not specifically address how these technological or treatment advances may have influenced the study results. Future research could consider phase-based analyses using statistical methods such as mixed-effects models or time-series analyses to better account for the potential impacts of changes over time.

While the study has adjusted for many potential confounders, we suggest considering additional variables that could significantly affect cirrhosis progression. For example, smoking is a known risk factor for liver disease, and regular smokers may be at higher risk for liver fibrosis [2]. Including this factor in the analysis would provide a more comprehensive assessment of cirrhosis progression. Furthermore, variables such as physical activity levels [3], dietary habits [4] and nutritional status could also play a significant role in disease progression. Incorporating these factors could enhance the interpretability of the results. Additionally, conducting subgroup analyses based on smoking status, physical activity levels and nutritional status may reveal differences in follow-up rates, readmission rates and mortality. Such analyses could identify subgroups that may particularly benefit from specific interventions.

Based on the study's findings, several public health implications emerge. First, timely outpatient follow-up significantly reduces mortality in cirrhosis patients. Therefore, personalised interventions should be reinforced, especially in the early postdischarge period. Helping patients manage lifestyle factors related to cirrhosis can effectively improve health outcomes. At the community level, increasing access to healthy foods and exercise facilities, particularly in resource-poor areas, along with establishing health education programmes and support networks, can help patients manage their disease more effectively. At the policy level, the study highlights the significant impact of socioeconomic status and education levels on follow-up and prognosis. Policymakers should focus on strengthening health resource support for low-income groups, implementing alcohol control regulations and promoting public health education to reduce cirrhosis-related mortality and readmission rates while improving overall health outcomes.

In conclusion, Schechter et al.'s study provides valuable insights into the relationship between timely follow-up and mortality in cirrhosis patients, laying a strong foundation for future public health interventions.

Mo-Yao Tan: conceptualization, investigation, writing – original draft. Ping Zhang: writing – original draft. Ming Gao: conceptualization, methodology, writing – original draft.

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.18367 and https://doi.org/10.1111/apt.18376.