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BARCELONA, Spain — Remote monitoring via wearables, app-based symptom reporting, and clinician dashboards could help shift care for patients with advanced cirrhosis from repeated emergency admissions toward earlier intervention in the community.

Rajeshwar Prosad Mookerjee, MD, PhD, professor of translational hepatology at University College London and consultant hepatologist at the Royal Free Hospital, both in London, England, and colleagues developed CirrhoCare, a digital healthcare system designed for at-home monitoring and management of patients with decompensated cirrhosis. The system combines a smartwatch, blood pressure monitoring, bioimpedance scales, app-based patient-reported outcomes, and a cognitive testing app for early signs of encephalopathy, all integrated with two-way secure communication with clinicians.

“What connected care allows us to do is move from a reactive model of cirrhosis care to one where we can monitor patients continuously, intervene earlier, and manage many complications before they become repeated emergency admissions, prolonged hospital stays, and requiring intensive interventions,” said Mookerjee, speaking to Medscape News Europe prior to his talk at the European Association for the Study of the Liver (EASL) Congress 2026.

“The central issue is that patients with decompensated cirrhosis often deteriorate rapidly, even after recent discharge, and may experience bleeding, ascites, hepatic encephalopathy, kidney injury, or multi-organ dysfunction, although liver disease is the underlying driver,” he explained.

Mookerjee highlighted that in Europe and the US, at least 30% of patients are readmitted within 1 month and around 50% within 3 months of discharge.

“It is truly a multisystem disease, but traditional, prescriptive outpatient follow-up is poorly suited to detecting early decline,” he said. “We give them a clinic appointment and hope they last out until they come to that appointment.”

Mookerjee explained that current practice involves addressing complications as they occur in the hospital and then discharging the patient.

“But they are not fixed, and new events follow,” he said, emphasizing the unmet need to identify deterioration at a point where intervention can lead to improved patient outcomes.

Monitoring and Acting

Mookerjee is leading a study of “connected patients,” with an aim of not only collecting data but also generating actionable insights.

The UK Conformity Assessed CirrhoCare platform combines an Apple Watch, smartphone app, Bluetooth-linked blood pressure and temperature monitors, and digital weighing scales, with clinician dashboards and algorithms that stratify patients according to risk for deterioration based on deviations from individual trends.

“The key point is early intervention,” he said. Clinicians can ask patients to repeat measurements or adjust their medication remotely. They can also arrange an urgent review or direct patients to specialist care without routing them through emergency departments.

In a pilot study conducted during the COVID pandemic, the system was associated with a 38% reduction in hospital admissions. Mookerjee said the approach helped keep 80% of patients with ascites-related problems out of hospital by enabling remote management, including adjustment of diuretics.

Patients monitored through the system who did require admission had a mean hospital stay of less than 4 days vs typical stays of at least 7 days in this population.

Multicenter Trial Underway

The CirrhoCare trial is recruiting 214 patients across 15 UK hospitals, including secondary care centers and large teaching hospitals. The primary endpoint of the ongoing trial is whether CirrhoCare reduces the need for unplanned hospital intervention related to new liver complications within 90 days of discharge. Secondary outcomes include effects on disease severity scores, hospital readmissions, mortality, frailty, quality of life, healthcare costs, and patient experience and engagement.

The study will also assess whether remote monitoring can reduce length of hospital stay and improve management of specific cirrhosis complications, including ascites, encephalopathy, and infection.

Mookerjee said health economic data, currently still under analysis, will be critical for wider adoption. He estimated that one UK admission for this patient group costs around £16,000, whereas the combined hardware and software package costs around £700 and can be used for months. “By comparison, 1 outpatient day case for an ascites drain costs around £1200.”

The current trial is also expected to examine workflow implications for the UK’s National Health Service, including whether remote monitoring can help clinicians focus face-to-face appointments on patients most in need.

Patient Experience and Input Are Key 

Mookerjee said patient input has shaped several iterations of the system. One practical example was the challenges of handling a smartwatch; many patients with advanced cirrhosis have muscle wasting and weakness in the hands, making some wearable devices difficult to use.

“You have to think that through,” he said. “If you ask them to grab the bezel of a smartwatch and hold it tightly, they can’t do that.”

Patient feedback from the pilot was highly positive, he added, with some patients reluctant to return the equipment after the 90-day monitoring period. “They felt connected,” he said. “When they’re discharged from hospital, they are very alone. It’s a complex disease, and their understanding of what they’re supposed to do with their medication is often unclear.”

Equity and Access

Mookerjee also sees remote monitoring as a potential route to more equitable specialist care. Access to advanced liver disease services varies across the UK, with some regions less well served by specialist centers. “The point of digitization is equity of access,” he said. “If your local unit is a small district general hospital, it shouldn’t matter. The data can traffic through to a specialist center.”

He added that public and policy awareness of advanced cirrhosis remains poor, despite the growing burden of liver disease. “We need to increase awareness of what cirrhosis really is,” he said. “These are not just older patients at the end of life. Many are young, with families watching them deteriorate.”

Commenting for Medscape News Europe, Maxime Ronot, MD, PhD, professor of radiology at Université Paris Cité in Paris, France, who moderated the session, said remote monitoring approaches such as CirrhoCare appear promising and may become increasingly integrated into routine liver care.

“This type of connected monitoring system has a real chance of success,” Ronot said. “Younger generations are increasingly comfortable using digital tools, and we are now seeing accumulating evidence from ongoing randomized trials assessing whether these approaches can improve outcomes.”

Ronot suggested that remote monitoring may eventually extend beyond specialist hepatology centers into primary care settings, helping clinicians identify deterioration earlier and intervene before patients require emergency admission.

He also noted that systems requiring minimal patient input may achieve greater uptake and generate more reliable data. “The most powerful systems may ultimately be those that can monitor patients passively in the background rather than relying heavily on patients actively entering information,” he said.

Ronot cautioned that wider adoption of digital monitoring tools could also raise ethical and policy questions around data use, access, and healthcare expectations. “If these systems eventually prove highly effective, there may also be broader societal questions about how such monitoring is incorporated into healthcare systems and reimbursement models,” he said.

Mookerjee reported codeveloping CirrhoCare with collaborators, including the CEO of CyberLiver, who was involved in software coding and development. He reported having no personal financial conflicts outside a collaborative research grant supporting the pilot study. Ronot reported having no relevant financial relationships. The ongoing CirrhoCare trial is funded by the National Institute for Health and Care Research.