Prospective evaluation of a pilot implementation of liver health checks in primary care in England

Objective Liver disease is a growing public health concern worldwide with increasing morbidity and mortality driven by alcohol-related liver disease (ALD), viral hepatitis and metabolic dysfunction-associated steatotic liver disease (MASLD). Early detection of compensated advanced chronic liver disease (cACLD) is critical to enable timely intervention and hepatocellular carcinoma surveillance. However, case finding in primary care remains limited. Our aim was to evaluate the outcomes of a primary care case-finding programme. Methods Prospective evaluation of a pilot programme funded by National Health Service England across 12 primary care networks, implementing a non-invasive liver fibrosis assessment pathway using Fibrosis-4 (FIB-4), enhanced liver fibrosis (ELF) and vibration-controlled transient elastography. Adults with liver disease risk factors were identified via electronic health record searches and invited for testing. cACLD was defined as liver stiffness measurement (LSM) ≥11.5 kPa. Results Of 47 243 individuals eligible for testing, 11 908 (25.2%) had testing with FIB-4. Among these, 3.2% had LSM ≥11.5 kPa, indicating probable cACLD. Prevalence was highest in individuals with known ALD (5.1%), hepatitis C (4.8%), MASLD (3.8%) and type 2 diabetes mellitus (3.7%). Age, body mass index and known history of ALD were independently associated with cACLD. Pathway adherence varied, with 71.9% following the protocol (significant overinvestigation and underinvestigation). Reflex ELF testing significantly improved adherence. Conclusions This pilot demonstrates that liver fibrosis case finding in primary care can be conducted with reasonable uptake. However, suboptimal uptake and pathway adherence highlight the need for automated, integrated approaches. Work is ongoing to more clearly define the optimum case finding approach.