Real-world management of non-alcoholic steatohepatitis differs from clinical practice guideline recommendations and across regions.
Real-world management of non-alcoholic steatohepatitis differs from clinical practice guideline recommendations and across regions.
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DOI：
10.1016/j.jhepr.2021.100411
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Higgins V
中科院分区：
文献类型：
--
作者：
Anstee QM;Hallsworth K;Lynch N;Hauvespre A;Mansour E;Kozma S;Marino JP;Bottomley J;Piercy J;Higgins V
尽管有非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）患者的诊断和管理参考指南，但缺乏国家和区域指南，导致各地区患者管理存在差异。我们回顾性分析了来自欧盟5国、加拿大和中东地区的阿德尔菲真实世界NASH疾病特定计划™的患者特征和管理数据，以确定现实实践与参考指南所倡导的差距，而不考虑临床医生的认识或咨询指南。我们对内科医生（肝病学家、胃肠病学家、糖尿病学家）及其诊断为NASH的患者进行了分析。医生为接下来的5位咨询患者完成了患者记录表格，收集了患者护理信息，包括诊断和疾病管理。共有429名医生提供了2267名NASH患者的数据（欧洲5国，n = 1844；加拿大，n = 130；中东，n = 293）。患者年龄、医生定义的纤维化分期、合并症和症状以及诊断测试实践突出了地区间的统计学显著差异。在参考指南和现实世界的实践之间观察到实质性的脱节。使用肝功能检查、非侵入性检查（如超声和瞬态弹性成像）和排除其他情况的检查是次优的。尽管生活方式方面的建议被广泛提供，但患者很少被推荐给饮食、运动和生活方式方面的专家。三分之二的患者接受了NASH或相关基础疾病的标签外治疗，目的是改善NASH，最常见的是他汀类药物、二甲双胍和维生素e。现实世界的NASH管理方法因地区而异，并与以参考多学科指南为代表的拟议护理标准有所不同。建立、认识和遵守地区和国家指南可以改善NASH患者的识别和管理，并可能改善这一人群的预后。虽然有参考指南可用于指导NASH患者的管理，但这些指南并未被广泛使用，而且缺乏国家指南。我们的研究表明，欧盟、加拿大和中东的临床实践与建议的护理标准有何不同，特别是在如何诊断和治疗患者方面。更广泛地建立、了解和参考指南可以改善医生如何识别和管理NASH患者。NASH患者的诊断和治疗有参考指南。本分析比较了3个地区的参考指南和现实实践。在测试和治疗中，与参考指南有很大的偏差。转诊到饮食、运动和生活方式方面的专家是次优的。需要建立、认识和遵守国家指导方针。
Despite availability of diagnostic and management reference guidelines outlining standard of care for patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), national and regional guidelines are lacking, resulting in variations in patient management between regions. We retrospectively analyzed patient characteristics and management data from the Adelphi Real World NASH Disease Specific Programme™ for patients with NASH in the EU5, Canada, and the Middle East to identify gaps between real-world practice and that advocated by reference guidelines, irrespective of clinician awareness or consultation of guidelines. We performed an analysis of physicians (hepatologists, gastroenterologists, diabetologists) and their patients diagnosed with NASH. Physicians completed patient record forms for the next 5 consulting patients, collecting information on patient care, including diagnosis and disease management. A total of 429 physicians provided data for 2,267 patients with NASH (EU5, n = 1,844; Canada, n = 130; Middle East, n = 293). Patient age, physician-defined fibrosis stage, comorbidities and symptoms, and diagnostic testing practices highlighted statistically significant differences across regions. Substantial disconnects between reference guidelines and real-world practice were observed. Use of liver function tests, non-invasive tests (e.g. ultrasound and transient elastography), and tests to exclude other conditions was suboptimal. Although lifestyle advice was widely provided, patients were less commonly referred to diet, exercise, and lifestyle specialists. Two-thirds of patients were receiving off-label treatment for NASH or associated underlying conditions with the aim of improving NASH, most commonly statins, metformin, and vitamin E. Real-world NASH management approaches differ across regions and from proposed standard of care represented by reference multidisciplinary guidelines. Establishment and awareness of, and adherence to regional and national guidelines may improve identification and management of patients with NASH and potentially improve outcomes in this population. Although reference guidelines are available to guide the management of patients with NASH, these are not widely used and there is a lack of national guidelines. Our study shows how clinical practice in the EU, Canada, and Middle East differs from proposed standard of care, particularly relating to how patients are diagnosed and treated. Wider establishment of, awareness of, and reference to guidelines may improve how physicians identify and manage patients with NASH. Reference guidelines exist for the diagnosis and management of patients with NASH. This analysis compared reference guidelines and real-world practice in 3 regions. Substantial deviations from reference guidelines were seen in testing and treatment. Referral to diet, exercise, and lifestyle specialists was suboptimal. Establishment, awareness, and adherence to national guidelines is needed.
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影响因子：
2.7
作者：
Kumar, Rahul;Teo, Eng Kiong;Ang, Tiing Leong
通讯作者：
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影响因子：
3.1
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影响因子：
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影响因子：
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