ABSTRACT
Background: Ascites is a common, painful, and dangerous complication of cirrhosis Body weight is a reliable proxy for ascites volume Therefore, daily weight monitoring is recommended to optimize ascites management Methods: In this feasibility study, cirrhotic patients requiring ascites management were enrolled in the inpatient or outpatient setting Patients were given a Bluetooth-connected scale, which transmitted weight data to the PGHD Connect Smartphone App, and then via the cloud to the electronic medical record (EMR) Weights were monitored every weekday In the event of a weight change 5lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert The primary outcomes were percentage of enrolled days during which weight data was successfully transmitted to the EMR, and the percentage of weight alerts which prompted a response by the provider Results: 37 patients were enrolled from January 2019 to June 2020: 19 (51%) male, mean MELD score of 15 8 (SD 5 6), mean age 61 years (range 35-81), and 22 (59%) were enrolled as inpatients Cirrhosis etiology was non-alcoholic steatohepatitis in 32%, alcohol in 32%, and viral in 11% Seven patients (19%) patients were on a single diuretic at enrollment, 24 (65%) were on two diuretics, and 6 (16%) were on no diuretics Weight data was successfully transmitted to the EMR during 71% of study enrollment days, with technology issues reported on 10% of days Patients were more likely to weigh themselves in the morning, with 1067 weights transmitted before noon and 142 transmitted after noon Of 111 weight alerts to date, 57 (51%) were triggered by weight loss and 54 (49%) by weight gain Providers responded in some way to 96 (79%) weight alerts, and actively intervened in response to 53 (43%), for example by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose or requesting laboratory workup 17 of 37 (46%) patients prompted both weight increase and weight decrease alerts during the study period, 10 (27%) prompted only weight decrease alerts, 5 (13%) prompted only weight increase alerts, and 5 (13%) patients prompted no alerts There were 22 readmissions for any reason over the course of the study period 24 (65%) patients opted to extend their participation beyond the initial 28-day study period Conclusion: We demonstrate feasibility of a telemonitoring system to facilitate ascites management We report excellent rates of patient and provider engagement, including during the COVID-19 era This innovation could enable early therapeutic intervention, decreasing the burden of morbidity and mortality among cirrhotic patients.