{
  "abstract": "Background and Aims Liver disease is a growing public health concern worldwide with increasing morbidity and mortality driven by alcohol-related liver disease (ARLD), viral hepatitis, and metabolic dysfunction–associated steatotic liver disease (MASLD). Early detection of compensated advanced chronic liver disease (cACLD) is critical to enable timely intervention and hepatocellular carcinoma (HCC) surveillance. However, case finding in primary care remains limited. Our aim was to evaluate the outcomes of implementation of a case finding programme in primary care.Methods We conducted a prospective evaluation of a pilot programme funded by NHS England across 12 Primary Care Networks (PCNs), implementing a non-invasive liver fibrosis assessment pathway using FIB-4, Enhanced Liver Fibrosis (ELF) testing, and vibration-controlled transient elastography (VTCE). Adults with liver disease risk factors were identified via electronic health record searches and invited for testing. cACLD was defined as liver stiffness measurement (LSM) ≥11.5 kPa.Results Of 47,243 individuals identified, 11,908 (25.2%; mean age 62 ±12 years, 59% male, 65% obese, 42% T2DM, 26% consumed >30 units alcohol/wk) underwent FIB-4 testing. Among these, 3.2% had LSM ≥11.5 kPa, indicating probable cACLD. Prevalence was highest in individuals with ARLD (5.1%), hepatitis C (4.8%), MASLD (3.8%), and T2DM (3.7%). Factors independently associated with cACLD after multivariate analysis were age (OR 1.023), BMI (OR 1.049) and known ARLD (OR 4.12). Pathway adherence varied, with 72% following the protocol (significant over and under investigation). Reflex ELF testing significantly improved adherence to pathway (p<0.001). Figure 1 shows tests results for patients who followed the pathway as per protocol. FIB-4 testing demonstrated reduced sensitivity in individuals with T2DM (18.5% of cACLD cases missed using age adjusted cut-offs), with the majority of these aged >65 years.Conclusions This pilot demonstrates the feasibility of implementing liver fibrosis case finding in primary care at scale. However, suboptimal uptake and pathway adherence highlight the need for automated, integrated approaches. Work is ongoing to more clearly define the optimum case finding approach.Abstract O2 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Liver Unit and NHIR Biomedical Research centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom",
        "Newcastle University, Newcastle upon Tyne, United Kingdom"
      ],
      "name": "Hannah Starr"
    },
    {
      "affiliations": [
        "NHS England, London, United Kingdom"
      ],
      "name": "Amy Newman"
    },
    {
      "affiliations": [
        "NHS England, London, United Kingdom"
      ],
      "name": "Mhukti Perumal"
    },
    {
      "affiliations": [
        "NHS England, London, United Kingdom"
      ],
      "name": "Chelsea Stuart"
    },
    {
      "affiliations": [
        "Aylesbury Central PCN"
      ],
      "name": "Kathy Hoffman"
    },
    {
      "affiliations": [
        "Pathfields Medical Group"
      ],
      "name": "James Boorer"
    },
    {
      "affiliations": [
        "Lambeth GP Federation"
      ],
      "name": "Jayesh Patel"
    },
    {
      "affiliations": [
        "Hammersmith and Fulham Partnership"
      ],
      "name": "David Wingfield"
    },
    {
      "affiliations": [
        "Kingston GP Chambers"
      ],
      "name": "Chole Pusey"
    },
    {
      "affiliations": [
        "Harness North PCN"
      ],
      "name": "Madhukar Patel"
    },
    {
      "affiliations": [
        "Torquay Primary Care Network"
      ],
      "name": "Mark Knight"
    },
    {
      "affiliations": [
        "Mid Hampshire Healthcare"
      ],
      "name": "Lucy Aubin"
    },
    {
      "affiliations": [
        "Winchester City PCN"
      ],
      "name": "Annie He"
    },
    {
      "affiliations": [
        "Wigan Borough Federated Healthcare"
      ],
      "name": "Mike Shinks"
    },
    {
      "affiliations": [
        "North West Leicestershire PCN"
      ],
      "name": "Neha Popat"
    },
    {
      "affiliations": [
        "Healthy Hyde PCN"
      ],
      "name": "Jordan Mountford"
    },
    {
      "affiliations": [
        "Hammersmith and Fulham Partnership"
      ],
      "name": "Maria Salman"
    },
    {
      "affiliations": [
        "St George’s University Hospital NHS Foundation Trust, London"
      ],
      "name": "Daniel Forton"
    },
    {
      "affiliations": [
        "Roger Williams Institute of Liver Studies, King’s College London"
      ],
      "name": "Philip Newsome"
    },
    {
      "affiliations": [
        "Liver Unit and NHIR Biomedical Research centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom",
        "Newcastle University, Newcastle upon Tyne, United Kingdom"
      ],
      "name": "Stuart McPherson"
    }
  ],
  "title": "O2 A prospective evaluation of a pilot implementation of liver health checks in primary care in England",
  "uid": "6173ea42-6171-5168-9d4d-b4f5a48c45f2"
}