National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

Wenhao Li; David Sheridan; Stuart McPherson; William Alazawi; Kush Abeysekera; Tom Marjot; Paul Brennan; Sara Mahgoub; Tessa Cacciottolo; Theresa Hydes; Tim Hardy; Gio McGinty; Oliver Tavabie; Jennifer Cathcart; Chirantha Premathilaka; Ashis Mukhopadhya; Arshiya Bhat; Shahnaz Begum; Bashar Abushaban; Meha Bhuva; Sophie Sinclair; Damien Leith; Cullen McCulloch; Joanna Leithead; Richard Fox; MH Shah; Eugene Campbell; Edward Brown; Dina Mansour; F Shah; Michael Allison; Jonathan Chan; Victoria Roberts; Gautham Appanna; Mandour Omer Mandour; Georgina Slee; Vicki Wong; Sreelakshmi Kotha; Katrina Pekarska; Richard Parker; Cyril Sieberhagen; Thomas Ngan; Esra Asilmaz; Hamish Miller; Jeremy Cobbold; Dom Crocombe; Manolis Tsochatzis; Sudeep Tanwar; Aruna Dias; Gurmit Singh; S Agrawal; P Chhabra; A Gurung; R Veettil; RD Abeles; D Chatterjee; M Carbonell; Z Mohamed; A El-Sayed; A Johnson; Damien Leith; S Barclay; K Kelly; J Munonye; D Coates; O Bamidele; T Johnston; D Samuel; B Ball; R Arscott-Samuel; P Hams; M Armstrong; A Elkhol; K Shailesh; V Bains; P Manousou; T Gupta; S Than; E Unitt; V Gordon; A Wakefield; S Gilchrist; I Cozma; S Saeed; S Umrani; K Olsen

doi:10.1016/j.jhepr.2023.100897

National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

Wenhao Li, David Sheridan, Stuart McPherson^*, William Alazawi, Kush Abeysekera, Tom Marjot, Paul Brennan, Sara Mahgoub, Tessa Cacciottolo, Theresa Hydes, Tim Hardy, Gio McGinty, Oliver Tavabie, Jennifer Cathcart, Chirantha Premathilaka, Ashis Mukhopadhya, Arshiya Bhat, Shahnaz Begum, Bashar Abushaban, Meha BhuvaSophie Sinclair, Damien Leith, Cullen McCulloch, Joanna Leithead, Richard Fox, MH Shah, Eugene Campbell, Edward Brown, Dina Mansour, F Shah, Michael Allison, Jonathan Chan, Victoria Roberts, Gautham Appanna, Mandour Omer Mandour, Georgina Slee, Vicki Wong, Sreelakshmi Kotha, Katrina Pekarska, Richard Parker, Cyril Sieberhagen, Thomas Ngan, Esra Asilmaz, Hamish Miller, Jeremy Cobbold, Dom Crocombe, Manolis Tsochatzis, Sudeep Tanwar, Aruna Dias, Gurmit Singh, S Agrawal, P Chhabra, A Gurung, R Veettil, RD Abeles, D Chatterjee, M Carbonell, Z Mohamed, A El-Sayed, A Johnson, Damien Leith, S Barclay, K Kelly, J Munonye, D Coates, O Bamidele, T Johnston, D Samuel, B Ball, R Arscott-Samuel, P Hams, M Armstrong, A Elkhol, K Shailesh, V Bains, P Manousou, T Gupta, S Than, E Unitt, V Gordon, A Wakefield, S Gilchrist, I Cozma, S Saeed, S Umrani, K Olsen

^*Corresponding author for this work

Peninsula Medical School

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Abstract

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. Methods: This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Results: Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. Conclusions: This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. Impact and implications: This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.

Original language	English
Number of pages	0
Journal	JHEP Reports
Volume	5
Issue number	12
Early online date	Dec 2023
DOIs	https://doi.org/10.1016/j.jhepr.2023.100897
Publication status	Published - Dec 2023

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Li, W., Sheridan, D., McPherson, S., Alazawi, W., Abeysekera, K., Marjot, T., Brennan, P., Mahgoub, S., Cacciottolo, T., Hydes, T., Hardy, T., McGinty, G., Tavabie, O., Cathcart, J., Premathilaka, C., Mukhopadhya, A., Bhat, A., Begum, S., Abushaban, B., ... Olsen, K. (2023). National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022. JHEP Reports, 5(12). https://doi.org/10.1016/j.jhepr.2023.100897

@article{720df1d82ab34c7d8c35608332ff6946,

title = "National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022",

abstract = "Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. Methods: This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Results: Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. Conclusions: This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. Impact and implications: This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.",

author = "Wenhao Li and David Sheridan and Stuart McPherson and William Alazawi and Kush Abeysekera and Tom Marjot and Paul Brennan and Sara Mahgoub and Tessa Cacciottolo and Theresa Hydes and Tim Hardy and Gio McGinty and Oliver Tavabie and Jennifer Cathcart and Chirantha Premathilaka and Ashis Mukhopadhya and Arshiya Bhat and Shahnaz Begum and Bashar Abushaban and Meha Bhuva and Sophie Sinclair and Damien Leith and Cullen McCulloch and Joanna Leithead and Richard Fox and MH Shah and Eugene Campbell and Edward Brown and Dina Mansour and F Shah and Michael Allison and Jonathan Chan and Victoria Roberts and Gautham Appanna and Mandour, {Mandour Omer} and Georgina Slee and Vicki Wong and Sreelakshmi Kotha and Katrina Pekarska and Richard Parker and Cyril Sieberhagen and Thomas Ngan and Esra Asilmaz and Hamish Miller and Jeremy Cobbold and Dom Crocombe and Manolis Tsochatzis and Sudeep Tanwar and Aruna Dias and Gurmit Singh and S Agrawal and P Chhabra and A Gurung and R Veettil and RD Abeles and D Chatterjee and M Carbonell and Z Mohamed and A El-Sayed and A Johnson and Damien Leith and S Barclay and K Kelly and J Munonye and D Coates and O Bamidele and T Johnston and D Samuel and B Ball and R Arscott-Samuel and P Hams and M Armstrong and A Elkhol and K Shailesh and V Bains and P Manousou and T Gupta and S Than and E Unitt and V Gordon and A Wakefield and S Gilchrist and I Cozma and S Saeed and S Umrani and K Olsen",

year = "2023",

month = dec,

doi = "10.1016/j.jhepr.2023.100897",

language = "English",

volume = "5",

journal = "JHEP Reports",

issn = "2589-5559",

publisher = "Elsevier B.V.",

number = "12",

}

Li, W, Sheridan, D, McPherson, S, Alazawi, W, Abeysekera, K, Marjot, T, Brennan, P, Mahgoub, S, Cacciottolo, T, Hydes, T, Hardy, T, McGinty, G, Tavabie, O, Cathcart, J, Premathilaka, C, Mukhopadhya, A, Bhat, A, Begum, S, Abushaban, B, Bhuva, M, Sinclair, S, Leith, D, McCulloch, C, Leithead, J, Fox, R, Shah, MH, Campbell, E, Brown, E, Mansour, D, Shah, F, Allison, M, Chan, J, Roberts, V, Appanna, G, Mandour, MO, Slee, G, Wong, V, Kotha, S, Pekarska, K, Parker, R, Sieberhagen, C, Ngan, T, Asilmaz, E, Miller, H, Cobbold, J, Crocombe, D, Tsochatzis, M, Tanwar, S, Dias, A, Singh, G, Agrawal, S, Chhabra, P, Gurung, A, Veettil, R, Abeles, RD, Chatterjee, D, Carbonell, M, Mohamed, Z, El-Sayed, A, Johnson, A, Leith, D, Barclay, S, Kelly, K, Munonye, J, Coates, D, Bamidele, O, Johnston, T, Samuel, D, Ball, B, Arscott-Samuel, R, Hams, P, Armstrong, M, Elkhol, A, Shailesh, K, Bains, V, Manousou, P, Gupta, T, Than, S, Unitt, E, Gordon, V, Wakefield, A, Gilchrist, S, Cozma, I, Saeed, S, Umrani, S & Olsen, K 2023, 'National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022', JHEP Reports, vol. 5, no. 12. https://doi.org/10.1016/j.jhepr.2023.100897

TY - JOUR

T1 - National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

AU - Li, Wenhao

AU - Sheridan, David

AU - McPherson, Stuart

AU - Alazawi, William

AU - Abeysekera, Kush

AU - Marjot, Tom

AU - Brennan, Paul

AU - Mahgoub, Sara

AU - Cacciottolo, Tessa

AU - Hydes, Theresa

AU - Hardy, Tim

AU - McGinty, Gio

AU - Tavabie, Oliver

AU - Cathcart, Jennifer

AU - Premathilaka, Chirantha

AU - Mukhopadhya, Ashis

AU - Bhat, Arshiya

AU - Begum, Shahnaz

AU - Abushaban, Bashar

AU - Bhuva, Meha

AU - Sinclair, Sophie

AU - Leith, Damien

AU - McCulloch, Cullen

AU - Leithead, Joanna

AU - Fox, Richard

AU - Shah, MH

AU - Campbell, Eugene

AU - Brown, Edward

AU - Mansour, Dina

AU - Shah, F

AU - Allison, Michael

AU - Chan, Jonathan

AU - Roberts, Victoria

AU - Appanna, Gautham

AU - Mandour, Mandour Omer

AU - Slee, Georgina

AU - Wong, Vicki

AU - Kotha, Sreelakshmi

AU - Pekarska, Katrina

AU - Parker, Richard

AU - Sieberhagen, Cyril

AU - Ngan, Thomas

AU - Asilmaz, Esra

AU - Miller, Hamish

AU - Cobbold, Jeremy

AU - Crocombe, Dom

AU - Tsochatzis, Manolis

AU - Tanwar, Sudeep

AU - Dias, Aruna

AU - Singh, Gurmit

AU - Agrawal, S

AU - Chhabra, P

AU - Gurung, A

AU - Veettil, R

AU - Abeles, RD

AU - Chatterjee, D

AU - Carbonell, M

AU - Mohamed, Z

AU - El-Sayed, A

AU - Johnson, A

AU - Leith, Damien

AU - Barclay, S

AU - Kelly, K

AU - Munonye, J

AU - Coates, D

AU - Bamidele, O

AU - Johnston, T

AU - Samuel, D

AU - Ball, B

AU - Arscott-Samuel, R

AU - Hams, P

AU - Armstrong, M

AU - Elkhol, A

AU - Shailesh, K

AU - Bains, V

AU - Manousou, P

AU - Gupta, T

AU - Than, S

AU - Unitt, E

AU - Gordon, V

AU - Wakefield, A

AU - Gilchrist, S

AU - Cozma, I

AU - Saeed, S

AU - Umrani, S

AU - Olsen, K

PY - 2023/12

Y1 - 2023/12

N2 - Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. Methods: This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Results: Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. Conclusions: This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. Impact and implications: This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.

AB - Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. Methods: This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Results: Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. Conclusions: This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. Impact and implications: This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.

U2 - 10.1016/j.jhepr.2023.100897

DO - 10.1016/j.jhepr.2023.100897

M3 - Article

SN - 2589-5559

VL - 5

JO - JHEP Reports

JF - JHEP Reports

IS - 12

ER -

National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

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