Trends in user ratings and reviews of a popular yet inaccurate blood pressure-measuring smartphone app.

Objective: To understand whether user reviews of Instant Blood Pressure (IBP), an inaccurate, unregulated BP-measuring app reflected IBP's inaccuracy, to understand drivers for high and low ratings, and to understand if disclaimers prevented medical use. Materials and Methods: All iTunes app reviews for IBP v1.2.3 were downloaded and assessed for themes by two reviewers. Summary statistics for themes were tabulated with their associated star ratings. Results: Common themes included perceived accuracy (42% of all reviews, star rating mean 4.8, median 5), inaccuracy (10%, 2.0, 1), and convenience (34%, 4.7, 5). Nine percent documented IBP use in medical conditions (4.6, 5), and 2% mentioned IBP's disclaimer (2.7, 3). Discussion: User reviews and ratings of a popular, inaccurate BP-measuring app were positive and uncommonly commented on its inaccuracy. Disclaimers attempting to prevent medical use of the app were ineffective. These findings support the need for more rigorous regulatory review of apps prior to their release.

User experience of instant blood pressure: exploring reasons for the popularity of an inaccurate mobile health app.

Instant blood pressure (IBP) is a top-selling yet inaccurate blood pressure (BP)-measuring app that underreports elevated BP. Its iTunes app store user ratings and reviews were generally positive. Whether underreporting of elevated BP improves user experience is unknown. Participants enrolled at five clinics estimated their BP, measured their BP with IBP, then completed a user experience survey. Participants were grouped based on how their IBP BP measurements compared to their estimated BP (IBP Lower, IBP Similar, or IBP Higher). Logistic regressions compared odds of rating "agree" or "strongly agree" on survey questions by group. Most participants enjoyed using the app. In the adjusted model, IBP Higher had significantly lower proportions reporting enjoyment and motivation to check BP in the future than IBP Similar. All three groups were comparable in perceived accuracy of IBP and most participants perceived it to be accurate. However, user enjoyment and likelihood of future BP monitoring were negatively associated with higher-than-expected reported systolic BP. These data suggest reassuring app results from an inaccurate BP-measuring app may have improved user experience, which may have led to more positive user reviews and greater sales. Systematic underreporting of elevated BPs may have been a contributor to the app's success. Further studies are needed to confirm whether falsely reassuring output from other mobile health apps improve user experience and drives uptake.

The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review.

Cardiovascular disease is a leading cause of morbidity and mortality worldwide, and a key barrier to improved outcomes is medication non-adherence. The aim of this study is to review the role of mobile health (mHealth) tools for improving medication adherence in patients with cardiovascular disease. We performed a systematic search for randomized controlled trials that primarily investigated mHealth tools for improving adherence to cardiovascular disease medications in patients with hypertension, coronary artery disease, heart failure, peripheral arterial disease, and stroke. We extracted and reviewed data on the types of mHealth tools used, preferences of patients and healthcare providers, the effect of the mHealth interventions on medication adherence, and the limitations of trials. We identified 10 completed trials matching our selection criteria, mostly with <100 participants, and ranging in duration from 1 to 18 months. mHealth tools included text messages, Bluetooth-enabled electronic pill boxes, online messaging platforms, and interactive voice calls. Patients and healthcare providers generally preferred mHealth to other interventions. All 10 studies reported that mHealth interventions improved medication adherence, though the magnitude of benefit was not consistently large and in one study was not greater than a telehealth comparator. Limitations of trials included small sample sizes, short duration of follow-up, self-reported outcomes, and insufficient assessment of unintended harms and financial implications. Current evidence suggests that mHealth tools can improve medication adherence in patients with cardiovascular diseases. However, high-quality clinical trials of sufficient size and duration are needed to move the field forward and justify use in routine care.

Mobile Health Initiatives to Improve Outcomes in Primary Prevention of Cardiovascular Disease.

OPINION STATEMENT: Cardiovascular disease affects more than a third of American adults and is the leading cause of mortality in the USA. Over the last 40 years, several behavioral and medical risk factors have been recognized as major contributors to cardiovascular disease. Effective management of many of these risk factors, particularly behavioral risk factors, remains challenging. With the growth of mobile health (mHealth) technology, a variety of novel strategies are now available to facilitate the delivery of interventions directed at reducing these risk factors. In this review, we discuss recent clinical studies and technologic innovations leveraging smartphone devices, social media, and wearable health tracking devices to facilitate behavioral interventions directed at three important and highly prevalent behavioral risk factors for cardiovascular disease: smoking, physical inactivity, and sub-optimal nutrition. We believe this technology has significant potential to provide low-cost, scalable, and individualized tools to improve management of these important cardiovascular disease risk factors.