Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS)

Ruth M Masterson Creber, Mathew S Maurer, Meghan Reading, Grenny Hiraldo, Kathleen T Hickey, Sarah Iribarren, Ruth M Masterson Creber, Mathew S Maurer, Meghan Reading, Grenny Hiraldo, Kathleen T Hickey, Sarah Iribarren

Abstract

Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need.

Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management.

Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, "heart failure," "cardiology," "heart failure and self-management"). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion.

Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps.

Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps.

Keywords: heart failure; mobile apps; mobile health; nursing informatics; review; self-care; self-management; symptom assessment.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Screening process flowchart.
Figure 2
Figure 2
Functionality of included apps based on IMS Institute for Healthcare Informatics functionality scores.
Figure 3
Figure 3
Symptom tracking features. Heart Failure Health Storylines (left image) enables tracking symptoms over time and Symple (right image) enables reporting symptoms for a single day and visualization of individual graphs by symptom.

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