BACKGROUND Free mobile applications (apps) that use photoplethysmography (PPG) waveforms may extend atrial fibrillation (AF) detection to underserved populations, but they have not been rigorously evaluated.OBJECTIVE The purpose of this study was to systematically review and evaluate the quality, functionality, and adherence to selfmanagement behaviors of existing mobile apps for AF.METHODS We systematically searched 3 app stores for apps that were free, available in English, and intended for use by patients to detect and manage AF. A minimum of 2 reviewers evaluated (1) app quality, using the Mobile Application Rating Scale (MARS); (2) functionality using published criteria; and (3) features that support 4 self-management behaviors (including PPG waveform monitoring) identified using evidence-based guidelines. Interrater reliability between the reviewers was calculated. RESULTSOf 12 included apps, 5 (42%) scored above average for quality (MARS score 3.0). App quality was highest for their ease of use, navigation, layout, and visual appeal (eg, functionality and aesthetics) and lowest for their behavioral change support and subjective impressions of quality. The most common app functionalities were capturing and graphically displaying user-entered data (n 5 9 [75%]). Nearly all apps (n 5 11 [92%]) supported PPG waveform monitoring, but only 2 (17%) supported all 4 selfmanagement behaviors. Interrater reliability was high (0.75-0.83).CONCLUSION The reviewed apps had wide variability in quality, functionality, and adherence to self-management behaviors. Given the accessibility of these apps to underserved populations and the tremendous potential they hold for improving AF detection and management, high priority should be given to improving app quality and functionality.
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