Review and Comparative Evaluation of Mobile Apps for Cardiovascular Risk Estimation: Usability Evaluation Using mHealth App Usability Questionnaire.

Abstract

Background: Cardiovascular diseases (CVD) are the leading cause of death and disability worldwide, and their prevention is a major public health priority. Detecting health issues early and assessing risk levels can significantly improve the chances of reducing mortality. Mobile apps can help estimate and manage CVD risks by providing users with personalized feedback, education, and motivation. Incorporating visual analysis into apps is an effective method for educating society. However, the usability evaluation and inclusion of visualization of these apps are often unclear and variable.

Objective: The primary objective of this study is to review and compare the usability of existing apps designed to estimate CVD risk using the mHealth App Usability Questionnaire (MAUQ). This is not a traditional usability study involving user interaction design, but rather an assessment of how effectively these applications meet usability standards as defined by the MAUQ.

Methods: First, we used predefined criteria to review 16 out of 2238 apps to estimate CVD risk in the Google Play Store and the Apple App Store. Based on the apps' characteristics (ie, developed for health care professionals or patient use) and their functions (single or multiple CVD risk calculators), we conducted a descriptive analysis. Then we also compared the usability of existing apps using the MAUQ and calculated the agreement among 3 expert raters.

Results: Most apps used the Framingham Risk Score (8/16, 50%) and Atherosclerotic Cardiovascular Disease Risk (7/16, 44%) prognostic models to estimate CVD risk. The app with the highest overall MAUQ score was the MDCalc Medical Calculator (mean 6.76, SD 0.25), and the lowest overall MAUQ score was obtained for the CardioRisk Calculator (mean 3.96, SD 0.21). The app with the highest overall MAUQ score in the "ease-of-use" domain was the MDCalc Medical Calculator (mean 7, SD 0); in the domain "interface and satisfaction," it was the MDCalc Medical Calculator (mean 6.67, SD 0.33); and in the domain "usefulness," it was the ASCVD Risk Estimator Plus (mean 6.80, SD 0.32).

Conclusions: We found that the Framingham Risk Score is the most widely used prognostic model in apps for estimating CVD risk. The "ease-of-use" domain received the highest ratings. While more than half of the apps were suitable for both health care professionals and patients, only a few offered sophisticated visualizations for assessing CVD risk. Less than a quarter of the apps included visualizations, and those that did were single calculators. Our analysis of apps showed that they are an appropriate tool for estimating CVD risk.