Most Patients With Clinically Significant Portal Hypertension Are Not Receiving Mortality Improving Therapy
W. Shanahan, M. Clarke, A. Ruxton, P. Dillon, D. Noone, L. Stobie, J.D. Ryan
Department of Hepatology, Beaumont Hospital, Beaumont, Dublin
Carvedilol has recently been shown by meta-analysis to be the first therapy to decrease the risk of decompensation and improve survival in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH). CSPH may be diagnosed non-invasively with a transient elastography (TE) score ≥25kPa, regardless of the presence of oesophageal varices, as per the Baveno VII guidelines.
To establish the number of patients with compensated cirrhosis and CSPH who are on carvedilol.
Patients with TE score ≥25kPa were identified from the local TE database. Only scans performed with a calibrated machine and valid performance metrics (IQR/MED ≤30%, ≥10 measurements) were included. Patient records were then reviewed to ascertain prescription data.
170 records were screened. 15 duplicate records were excluded. 13 were excluded due to decompensation or death. 7 were excluded due to subsequent TE <25kPa or liver transplant. 29 were excluded due to unavailable prescription data. Of the 106 remaining, 22.6% (24) were on carvedilol and 0% (0) were on propranolol. 3.7% (4) had a documented intolerance or contraindication. 73.6% (78) patients in this cohort with compensated cirrhosis and CSPH were not on any non-selective beta blocker.
The number of patients with CSPH on mortality benefitting therapy in the form of carvedilol is low. There is significant scope to improve outcomes for patients with compensated cirrhosis by starting all such patients with CSPH on carvedilol, regardless of the presence of oesophageal varices.