Table 2.

Studies on telemonitoring to prevent clinical decompensation in cirrhotic patients.

Study (Year) Design	Aim of the Study	Time Frame	Condition	Participants Exposed	Intervention/Exposure	Comparison	Outcomes	Sum of Results and Conclusion
Bloom, 2022 [7] Observational, prospective	To evaluate the cost and outcomes of current care compared to a telemonitoring system for ascites.	6 months	Cirrhosis	100	The telemonitoring system tracks patient weight remotely through Bluetooth-enabled scales and provides automated, early alerts to providers about weight changes.	100	Global costs. No. of hospital admissions. No. of office visits. No. of paracentesis.	A telemonitoring intervention is cost-saving for the management of cirrhotic ascites.
Ganapathy, 2017 [22] Observational, prospective	To evaluate the feasibility of using the Patient Buddy App and its impact on 30-day encephalopathy-related readmissions by engaging and educating cirrhotic inpatients and caregivers.	30 days post-discharge	Cirrhosis	40	The Patient Buddy focused on (a) medication and sodium intake adherence, (b) weight, and (c) orientation and cognition. The app automatically generates alerts for missed critical medications, missed measurements, significant changes to weight, or orientation/cognition scores, and contacts with on-call physicians or emergency services.	None	30-day readmission rate.	The use of Patient Buddy is feasible in recently discharged patients with cirrhosis and their caregivers.
Bajaj, 2015 [26] Observational, prospective	To validate the ability of the smartphone app EncephalApp, a streamlined version of the Stroop App, to detect covert hepatic encephalopathy.	NS	Cirrhosis and OHE	167	EncephalApp	114	EncephalApp and Paper&Pencil Test OffTime, OnTime, OffTime+OnTime, and number of runs required to complete five Off and On runs.	A smartphone app called EncephalApp has good face validity, test–retest reliability, and external validity for the diagnosis of CHE.
Oyelade, 2020 [30] Observational, prospective	To examine whether HRT parameters could predict mortality in cirrhotic patients.	12 months	Cirrhosis	40	24-h electrocardiograph (ECG) recordings suitable for HRT analysis were obtained using a wireless Holter recorder.	None	Mortality.	This study provides further evidence of autonomic dysfunction in cirrhosis, and suggests that HRT is a reliable alternative to HRV in patients with PVCs.
Jansen, 2019 [31] Observational, prospective	To validate wireless remote monitoring of HRV in AD patients, and establish whether HRV measurement is a surrogate for progression and inflammation, and if its measurement can determine prognosis in AD.	90-day follow-up between March 2013 and July 2015 in London and between February 2014 and January 2015 in Bonn	Cirrhosis	111	SDNN reflecting HRV using remote monitoring (Isansys Lifetouch) and/or Holter ECG recording.	NS	Disease progression and 90-day mortality.	SDNN predicted disease progression on repeat measures and appeared to be an independ- ent predictor of 90-day mortality (12 patients).
Thomson, 2015 [21] Observational, prospective	To investigate whether IVR monitoring can predict hospitalization and mortality in cirrhosis.	22 months	Cirrhosis	79	Patients using IVR hear recorded messages and respond to queries via their touch-tone phones. Based on their responses, they receive tailored self-management education. The focus of the questions was on factors previously identified as potential predictors of hospitalization or death among patients with cirrhosis.	None	Time to first hospital admission, hospitalization, and time to death.	IVR calls can be used to predict hospitalization in cirrhosis.
Luo, 2022 [27] Observational, retrospective	To compare the efficiency, convenience, accessibility, and acceptability of EncephalApp with that of eNCT-A for MHE screening in cirrhotic patients.	From January 2019 to January 2021	Cirrhosis	95	Both the EncephalApp Stroop test (EncephalApp) and eNCT-A were used for MHE screening.	150	The convenience, accessibility, and acceptability of PHES, EncephalApp and eNCT-A were respectively evaluated with the five-point Likert scale.	As with the EncephalApp, the eNCT-A will be a potential home monitoring and point-of-care tool for cirrhotic patients at high risk of MHE.
Khungar, 2017 [24] Observational, prospective (abstract)	To pilot a wireless mobile device monitoring system to detect early symptoms and signs, thereby preventing readmissions and keeping patients engaged and feeling cared for on a daily basis.	From 1 May 2010 to 7 July 2016	Cirrhosis	19	Biometric parameters, signs, and symptoms questionnaires were transmitted wirelessly. Physicians could intervene by phone or video chat.	143	N of readmissions.	A telehealth platform reduces readmissions for potentially preventable causes (HE and volume overload) and improves patient satisfaction.

OHE: overt hepatic encephalopathy; CHE: covert hepatic encephalopathy; HRT: heart rate turbulence; ECG: electrocardiograph; PVC: premature ventricular complexes; AD: acute decompensation; SDNN: standard deviation of all normal beat-beat intervals; IVR: interactive voice response; MHC: minimal hepatic encephalopathy; PHES: psychometric hepatic encephalopathy score; e-NCT-A: electronic number connection test-A; PPV: positive predictive value; NPV: negative predictive value.