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00:00:00 - Surf's Up: Season 5 Episode 21 
One important session at the EASL Congress 2024 involved the presentation of the new MASLD Clinical Practice Guidelines. CPG co-authors Elisabetta Bugianesi and Frank Tacke join Louise Campbell and Roger Green to share their perspectives on the guidelines' development some key recommendations.  

00:09:36 - Revising the guidelines 
Roger asks the co-authors to describe the process that led to the 2021 decision to revise the guidelines. EASL was the initial driver; EASD and EASO joined the process. They formed a committee of 15 leaders and assembled a Delphi panel of 46 individuals from different stakeholder communities.  

Elisabetta describes the "big advantage" of this collaboration: it conveyed the need for a common way to manage co-morbid patients with MASLD. To Frank, this approach strengthened the guidelines by putting the liver in the center of metabolic disease. 

Louise asks whether the guidelines will increase the profile of liver disease in other specialties. Elisabetta says "it takes time" but says that the nature of cirrhosis and HCC might make this easier.

00:19:07 - Adding resmetirom before approval
Earlier, Louise praised the inclusion of resmetirom in the guidelines, Frank notes that this section was added to the guidelines within a month before their release and praises the "very engaged Delphi panel" that reacted and voted quickly.  He proceeds to discuss how the Delphi panel was formed.

00:23:24 - Major issues in screening, diagnosing and case-managing patients
Elisabetta starts by saying that resmetirom's approval created momentum for screening. She says the approach identifies patients before cirrhosis or HCC in pre-cirrhotic patients. Frank points out "a major breakthrough": these guidelines do not rely on biopsy.  

00:28:04 - Non-medical factors 
Louise lauds the document's the broad range of diets that will make the document valuable around the world . Frank adds that the guidelines have adjusted thresholds  adapted to the ethnic and socioeconomic background of the individual. 

00:30:52 - Pharmacological issues in the new CPG 
Frank starts the pharmacological discussion noting that the CPG drives holistic thinking about the liver in a metabolic context. Elisabetta notes that while no drugs are efficacious for cirrhosis, the document does report that some drugs are safe for these patients, although sometimes with adjusted doses. 

00:33:39 - Screening for cirrhosis
Frank concurs that the document provides guidance on managing patients with end-stage liver disease and also discusses how to manage cirrhosis and its various complications. Elisabetta says that HCC can be hard to find in a fatty liver. 

00:36:36 - Cardiometabolic nursing as a future training and specialty
Louise suggests that these guidelines "pinpoint...a role of the potential future" for nurses who can support the entire cardiometabolic syndrome. This document might drive a curriculum for such a specialization.

00:38:48 - What adjustments would you like to see in the healthcare system?
The last set of questions begins with Roger asking what kinds of changes the authors would like to see in the healthcare system.  The discussion revolves around a "cardiometabolic" perspective but in terms of nurse training and the care provided in a hepatologist's office. 

00:43:18 - Winding down
As the conversation winds down, each panelist offers a final comment or question.

00:47:59 - Question of the Week
Roger asks how readily listeners believe the guidelines will be implemented, and which sections will be easiest and hardest to implement. 

00:48:32 - Business Report
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