S4-6.3 – Linking Cardiovascular Outcomes to Fatty Liver and Utilizing FIB-4 in Australia

S4-6.3 - Linking Cardiovascular Outcomes to Fatty Liver and Utilizing FIB-4 in Australia
The podcast heads Down Under as Louise Campbell hosts this week’s surf with Brisbane-based guest, Tony Rahman. In this conversation they explore use of FIB-4 and FibroScan, linking cardiovascular outcomes to Fatty Liver and establishing new systems to improve accessibility of care.

In an introduction to Fatty Liver in Australia, Louise Campbell is joined by Tony Rahman, Director of Gastroenterology & Hepatology at The Prince Charles Hospital in Brisbane and Adjunct Professor in the College of Medicine and Dentistry at James Cook University.

Louise starts this conversation with an anecdote from her experiences in Australia providing virtual clinics to those living 6 to 10 hours drive away from their nearest consultation. She follows with a question to Tony on whether GPs want to buy into NAFLD and NASH in the same way that they responded to successful Hepatitis C programs. Tony replies yes, but alludes to some challenges in doing so. He notes the influence of how a problem and solution are presented has on the uptake of interest and whether the benefits posed are considered worthwhile. He explains that GPs in Australia are paid per patient and time away for education can be perceived as a loss of income. He suggests that rather than solely “bombarding GPs with education,” change will more readily be adopted if there is a robust plan in place. Conducting various environmental tests – even as simple as a GP focus group – considerably improves uptake of a newly introduced initiative. He continues on to describe a traffic light system adopted by the Prince Charles Hospital that utilizes FibroScan to assess the likelihood of a patient to develop liver disease in a given time. Louise comments on the importance of seeking constant refinement in establishing such systems.

Discussion shifts to the topic of guidelines and use of FIB-4 in the primary care setting. Louise asks whether use of FIB-4 is a part of any Australian protocol and, if not, is there any traction for its positioning as a readily available tool for risk stratification. Tony maintains it is making headway along with calculating an AST to Platelet Ratio Index (APRI), a popular measurement in the efforts of moving patients along Hepatitis C treatment. Today, he is wary that GPs who are seeing a large number of patients may not have the time or prioritize making calculations. At this point, Louise points to the idea of joint referrals in light of emerging recommendations from the cardiology community on risk assessment of NAFLD. She notes the combined uptake of FIB-4 and FibroScan as something potentially valuable to an initiative such as Heart of Australia. Tony points out that establishing convincing clarity around the links between Fatty Liver disease and cardiovascular outcomes is conducive to the protocol-led Australian doctors. At the end of the session, Tony illustrates potential challenges in Australia not having a FibroScan medicare billing code and comments on factors which affect accessibility.

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