Inaugural Report Provides Insight Into Management and Trends of Chronic Liver Disease

By 2030, the incidence of chronic liver disease (CLD) and related mortality is expected to triple in the United States, which will have a big impact on the US health care system, according to a new report from Salix Pharmaceuticals.

The inaugural “Liver Health Annual Trends Report” surveyed 100 physicians who manage and treat CLD to paint a better picture of the disease. In addition, the report included secondary research of peer-reviewed publications, which have shown that CLD affected 4.5 million US adults in 2018. In addition, the review of research found that more people between the ages of 25 and 54 years are dying from CLD or cirrhosis than from diabetes or stroke.

“The demographics of this disease are changing in real time, and the liver health community must come together to understand the latest information, including evidence-based treatment options that provide hope for patients,” Robert Spurr, president of Salix, said in a statement.

The burden of CLD is substantial, both financially and on resources. Adult CLD-related hospitalizations cost $81.1 billion from 2012 to 2016. In addition, data from a large, diverse health care system in Texas showed that CLD hospitalizations from January 1, 2004, to December 31, 2013, increased significantly compared with hospitalizations related to congestive heart failure and chronic obstructive pulmonary disease.

The survey portion provided insight into trends affecting CLD patient management and sources of patient support. The respondents identified health behaviors (72%), access to health services (64%), and social support network and social inclusion (52%) as the top 3 social/economic factors that play the biggest role in influencing patient outcomes in CLD.

Among liver diseases, patients diagnosed with nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) had better outcomes because they had fewer issues with health insurance or social support networks. One physician said that in comparison, patients with end-stage liver disease often have no insurance, no provider, and no social support network.

The top overall factors influencing patient outcomes in CLD, according to the respondents, were treatment adherence (77%), alcohol and recreational drug use (76%), and treatment of the acute condition (eg, ascites, portal hypertension, varices, hepatic encephalopathy [HE]) (76%).

There are multiple guidelines available that addressed management of CLD, but 39% of respondents were unaware or unable to name national guidelines, while 42% named the American Association for the Study of Liver Diseases. Specialists’ utilization was highest (70%) compared with hospital-based physicians (30%) and primary care physicians (47%).

The report also looked at the impact of the COVID-19 pandemic on CLD care, and 21% of respondents said they observed increases in hospitalizations due to alcoholic cirrhosis. In addition, 19% said existing CLD patients had rapid disease progression, another 19% said they diagnosed more patients with CLD, 18% said they saw new patients presenting with increased severity of CLD, and another 18% saw increases in HE-related hospitalizations.

The most common purposes for telehealth visits for CLD patients were to provide advice to prevent decompensation (62%), provide routine care including medication management and answering questions (61%), coordinate complex care (56%), and provide urgent evaluations during decompensation events to minimize emergency department visits and admissions (56%).

“The importance of this first Liver Health Annual Trends Report cannot be overstated as the foundational element in understanding liver health as public health,” said Donna Cryer, JD, founder, president and CEO, Global Liver Institute. “The provision of accurate information on the underlying determinants of chronic liver disease and the economic, clinical, and social impacts are essential to reducing stigma, promoting health equity, and creating the urgency across the medical community to come together to address the needs of the 4.5 million Americans suffering from chronic liver disease and the millions more at risk.”