Why Are Liver Disease Patients Being Left Behind?

Approximately 4.5 million adults in the U.S. have chronic liver disease (CLD), which can lead to cirrhosis.¹ Often, cirrhosis is permanent liver damage, so earlier diagnosis and prevention are critical for patients living with liver disease.² As of 2022, CLD is the tenth leading cause of death in the U.S. with associated mortality projected to nearly triple by 2030.^1,3

This raises the question: why do these projections continue to rise and what can we, as healthcare providers (HCPs), do to help address it?

The Situation at Hand

Liver injury is often silent and there isn’t always consensus on whom to screen for liver disease. Even when an individual is recognized as having a liver disease, many HCPs seem to prefer specialists manage this population. Rapidly increasing patient volumes alongside the challenge of multidisciplinary care have led to backlogs of liver disease patients seeking specialist care.⁴ Too often, these patients are left with long wait times, lost to follow-up until they are presenting with symptoms of irreversible liver disease, and/or get assessed or diagnosed in the inpatient setting.

This means care for patients with CLD often falls on non-specialists. Stronger education and support can help ensure their patients receive timely, optimal care.⁴

An Urgent Need to Spark Actionable Change

Earlier this month, which happens to be Liver Awareness Month, Salix Pharmaceuticals released a new survey that included an immediate and critical call to action to improve liver disease management and outcomes for patients. Liver Health Trends Report in Action provides decisive, actionable strategies for physicians practicing in community-based primary care practices and inpatient hospital settings.⁴ HCP survey participants called for holistic, multidisciplinary treatment approaches, consistent use of noninvasive screening tools, and better education to identify at-risk patients sooner and prevent future complications of severe liver disease.⁴

Steps Have Been Made

The good news is that some progress has been made to create a multidisciplinary treatment model that begins with physicians practicing in the primary care setting. Recognizing the need to identify, diagnose, and treat patients with CLD earlier, the American Association of Clinical Endocrinology (AACE) developed screening and treatment guidelines for people at risk for MASLD (metabolic dysfunction associated steatotic liver disease) in the primary care setting, which were endorsed by the American Association for the Study of Liver Diseases (AASLD).⁵ An important feature of these types of guidelines is the utilization of noninvasive tests and the ability to stratify patients’ risk of developing cirrhosis (Fibrosis-4 [FIB-4]) and, for patients diagnosed with cirrhosis, to determine their risk of decompensation (liver stiffness measurement [LSM] plus platelet count).⁵ These types of diagnostic tests and scores can be a critical tool to help physicians determine which patients can be managed in the primary care setting and which require a referral to a specialist.

What Are the Next Steps?

This shift in the management of liver disease away from specialists to primary care settings or in community-based practices requires support from the leadership of group practices, hospitals, and health systems (as well as buy-in from the primary care providers). Physicians participating in the survey report that advances in liver disease management are achievable given the provision of resources and tools by their practice or organization’s leadership.⁴ Additional consistent use of diagnostic tests and scores can help identify severe disease earlier, and elevated national attention on liver disease as a public health priority may help lessen the burden of illness on the broader healthcare system.⁴

Overall, investing in the management of liver disease can help address the growing disease burden, reduce the overutilization of high-cost inpatient care, and improve outcomes.⁴

About the Report

Liver Health Trends Report in Action encompasses key learnings from 2020-2023 Liver Health Annual Trends Reports, new secondary and primary research, as well as forty in-depth interviews with physicians who treat liver disease across various practice settings to reveal insights on diagnosis, management, and barriers to liver disease care.⁴

Nancy S. Reau, MD, is chief of the hepatology section at Rush University Medical Center in Chicago. She served as editor of Clinical Liver Disease, a multimedia review journal, and recently as a member of HCVGuidelines.org, a web-based resource from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America, as well as educational chair of the AASLD hepatitis C special interest group. She continues to have an active role in the hepatology interest group of the World Gastroenterology Organization and the American Liver Foundation at the regional and national levels. Reau is a paid consultant to Salix Pharmaceuticals.

References

1. Centers for Disease Control and Prevention. (2024, September). Chronic liver disease and cirrhosis. https://www.cdc.gov/nchs/fastats/liver-disease.htm
2. Ginès, P., Krag, A., Abraldes, J., Solà, E., Fabrellas, N., & Kamath, P. (2021). Liver cirrhosis. The Lancet, 398, 1359-1376. https://doi.org/10.1016/S0140-6736(21)01374-X
3. Estes, C., Razavi, H., Loomba, R., Younossi, Z., & Sanyal, A. J. (2018). Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology (Baltimore, Md.), 67(1), 123–133. https://doi.org/10.1002/hep.29466
4. Aventria Health Group. (2024). Liver Health Trends Report in Action. Salix Pharmaceuticals. https://liverhealthnow.com/trendsreport
5. Cusi, Kenneth et al. (2022). American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings. AACE Endocrine Practice. Volume 28, Issue 5, 528 – 562. https://www.endocrinepractice.org/article/S1530-891X(22)00090-8/fulltext

The MedPage Today Editorial team was not involved in the creation of this content.

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