Smartphone Apps for Pulmonary Hypertension: A Systematic Search and Evaluation Content (Preprint)

Abstract

BACKGROUND Pulmonary hypertension (PH), is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and healthcare professionals in monitoring and managing PH more effectively. OBJECTIVE The review aimed to identify and assess the quality of free smartphone apps for PH targeted at both patients and healthcare professionals. METHODS A systematic search was conducted on freely available apps for PH patients and healthcare professionals, accessed from a Spain IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analysed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. RESULTS In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 6 updated since 2022. Twelve apps targeted patients/general population, while 9 targeted healthcare professionals; none involved patients in the development or design. Conversely, 13 apps involving healthcare professionals were identified. Ten apps received pharmaceutical industry funding. The apps primary goals for 81% were to disseminate general information about PH. The overall MARS quality was acceptable in 2022 and 2023, rated at 2.9 (0.6) and 3.0 (0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves however, two incorporated tools/algorithms derived from trials. The overall quality of iOS applications statistically outperformed that of Android applications in both years (p<0.05). Furthermore, the involvement of healthcare professionals in app development was associated with enhanced quality, a trend observed in both years (p<0.05). CONCLUSIONS This review of mHealth apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of healthcare professionals in app development, contributing significantly to their quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over two years points to a need for continuous innovation and clinical validation for effective clinical integration. Conclusively, this research advocates for future app developers to engage with healthcare professionals actively, integrate patient insights, and mandate rigorous clinical validation for PH management.