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APP REVIEWS

Atrial Fibrillation

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Dr. Jeff Ashley
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As Ontario’s population ages, the incidence of atrial fibrillation increases. We know that atrial fibrillation can be intermittent or asymptomatic. We also know that diagnosed or undiagnosed atrial fibrillation without proper stratification can lead to stroke. If physicians were able to identify these patients earlier and more efficiently, there could be a significant impact on the prevention of disability or death due to stroke. As smartphones are now ubiquitous and the use of mobile apps for health management is growing, it’s worth taking a look at whether apps can contribute to aFib management.

Currently, most patients are screened with 24 to 48 hour Holter monitors, with the requirement for patients with Transient Ischemic Attacks (TIAs) to wear them for up to 30 days. Some patients have intermittent atrial fibrillation that may not occur while wearing these devices. Approximately 25% of patients with stroke or TIAs have atrial fibrillation diagnosed after the event, so undoubtedly earlier diagnosis is preferred. (1). Finding an app that could help diagnose patients with irregular beats or just reassure ‘at risk’ patients who want screening at their fingertips, would help decrease patient morbidity, mortality and in some cases, anxiety about atrial fibrillation. In order to be useful for patients with known or suspected atrial fibrillation, these apps must be able to not only detect a heart rate, but actually differentiate between multitudes of heart rhythms to identify the unique pattern of atrial fibrillation. Promisingly, there have been studies showing that accurate diagnosis and monitoring of atrial fibrillation is possible using a smartphone (1).

Unfortunately, the apps we reviewed do not deliver these results. Validated apps with FDA approval in the U.S. are not yet licensed in Canada. While apps available in Canada do not provide significant value to patients with atrial fibrillation, some may provide small benefits as a simple heart rate monitor.

Apps Reviewed

Cardiio
3 stars3 stars3 stars3 stars3 stars
Photo AFib Detector
2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars
AF Detect
2 stars2 stars2 stars2 stars2 stars
Cardiograph
1.5 stars1.5 stars1.5 stars1.5 stars1.5 stars

Cardiograph

1.5 stars1.5 stars1.5 stars1.5 stars1.5 stars

Cardiograph is another app that sounds promising to detect our patient’s rhythms, but its very name is somewhat misleading. The app advertises that it uses the built-in camera to calculate your heart rhythm, but on testing, Cardiograph was only able to accurately record a pulse. It did not detect atrial fibrillation. The app is user friendly, has a data sharing capability with primary care provider, and personal health information is stored only on the device. Available for both iPhone and Android, Cardiograph is not recommended for the screening and/or diagnosis of atrial fibrillation.

Detailed Review View All

Features

+-

Although this app can be used on both iOS and Android devices, only the iPhone allows for Cardiograph to connect with Apple’s HealthKit. This feature allows users to track daily steps and distance travelled. The app provides what looks like a rhythm strip, but detects only heart rate, not cardiac rhythm.

Effectiveness

+-

The app only enables users to detect pulse, no rhythm. Though the app is visually appealing, depicting what looks like a heart tracing, it is ineffective for detecting atrial fibrillation.

Usability

+-

Once downloaded, the app is easy and simple to employ. Users of iOS devices can sync readings to HealthKit with minimal instruction.

Privacy & Security

+-

This app is not password protected. No privacy statement on the app; only in the App Store. Data is collected when employing the app, but it does not connect to the users’ personal information.

Reliability

+-

Last updated in January 2017, the app is reliable for logging and recording a user’s pulse, but not detecting atrial fibrillation.

Accessibility

+-

The app is available on iOS and Android devices at a cost of $2.79. Instructions are easy to follow and are available in multiple languages.

AF Detect

2 stars2 stars2 stars2 stars2 stars

AF Detect is another app that is supposed to be a heart rate monitor and detect atrial fibrillation on your smartphone. Though easy and clear to use, it did not detect atrial fibrillation in my tested patients.

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Features

+-

It was able to give an accurate pulse and took approximately 45 seconds to finish. The app does provide a good information about atrial fibrillation. The data can be exported via email directly to clinician for prompt assessment.

Effectiveness

+-

In a clinical setting, the app failed to detect atrial fibrillation in patients with this abnormality. There is no ability to record or share a rhythm strip. There are no studies validating the use of this app available on their website. This is not an accurate and reliable app for the detection or screening of atrial fibrillation. There is a disclaimer on the app stating it is not intended for medical diagnosis.

Usability

+-

This app is extremely easy to use and intuitive in nature. The journal feature allows for continuous documentation and a simplified record of heart rhythms at a glance. It is quite visually appealing and easy to navigate.

Privacy & Security

+-

This app clearly outlines the release of personal health information and the sharing of data to third parties. However, it does not specifically discuss if the health information collected will be used for research. Users are required only to provide their email address, and the rest of their personal information is optional and does not affect the usage of the app.

Reliability

+-

Overall, this app is not a reliable app when it comes to detecting atrial fibrillation. This app was last updated in May 2014.

Accessibility

+-

This app costs $2.79 through the App Store and is available for both iPhone and Android. It’s fairly simple and easy to use, but might be more difficult for patients with tremors or arthritis.

Photo AFib Detector

2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars

Photo AFib Detector suggests that it detects of atrial fibrillation, however its initial description says “this app is not to be used for medical diagnosis.” I tested the app on patients experiencing atrial fibrillation; app results indicated normal rhythm. The app does provide good information for patients with easy to understand illustrations. The app gives accurate pulse readings and heart tracing within 60 seconds but no better than a pulse detector. Photo AFib Detector is fairly easy to use with clear instructions and is visually appealing. Though the app did pick up an abnormal pulse, it was not helpful in the detection of atrial fibrillation.

Detailed Review View All

Features

+-

The app was developed for personal atrial fibrillation detection and heart rate monitoring, but the upfront qualifier ensures that patients and health professionals do not use it for medical diagnosis. The app has an impressive, well-diagrammed information page for patients to read and be able to visualize the risks of atrial fibrillation. It keeps an accurate recording of the user’s pulse reading history.

Effectiveness

+-

The app is effective in its detection of heart rate and will indicate to the user if the rhythm is normal or not. However, upon testing, Photo AFib Detector gave an abnormal result to a patient in sinus rhythm, and did not pick up atrial fibrillation on a patient in aFib. Pulse rates were always accurate. There was no way for the user to transmit data.

Usability

+-

Available on iOS and Android devices, the app is easy and simple to use and provides logical instructions to the user. Visual diagrams, along with information on atrial fibrillation, give the app an intuitive and easy interface.

Privacy & Security

+-

No privacy statement is available in the app or on the website. The app is not password protected.

Reliability

+-

The app was last updated in December 2015. This app is unreliable in detecting atrial fibrillation. Diagrams and information provided on this app are accurate, and considered a reliable source for patients when discussing health concerns with their doctors. The app’s website is in Chinese, making it difficult to get technical support.

Accessibility

+-

The app is available on both iOS and Android devices. It is available in Mandarin and Cantonese. The app is easy to navigate with clear and useful information. Users must be able to hold the smartphone with their finger on the sensor for at least one minute, preferably two, to detect reading. Cost is $1.99.

Cardiio

3 stars3 stars3 stars3 stars3 stars

This app is a great detector for heart rate using an iPhone camera. The cool factor is that the user only has to look directly at the screen for detection of heart rate, rather than previous iterations of placing a finger on the phone’s camera or sensor. It also keeps a record of the patient’s pulse. For the purposes of this review, however, Cardiio does not detect atrial fibrillation. The company states that it is actively performing research on detecting atrial fibrillation (3).

Detailed Review View All

Features

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While the app does not detect atrial fibrillation, it has several features that patients may use on a daily basis. For instance, it will remind you to check your pulse daily and is somewhat effective for patients looking to monitor their fitness levels and general endurance. Based on the endurance scores, it can provide a very crude guesstimate of your level of fitness based on age and heart rate. It does provide a wave form, but again not for diagnostic purposes. The full package app costs $6.99 and features a quick seven- minute exercise program, though users may have to pay $2.99 for a voice in their language or dialect. After taking a pulse, social media savvy users can add a note about how they feel and then share the results on Facebook, Twitter or via email.

Effectiveness

+-

Cardiio is not an effective app to detect atrial fibrillation. I was unable to detect aFib in my patients, and subsequently wrote the company to ask for assistance. They wrote back “is not intended to be utilized for medical purposes and is not intended to be used to diagnose, cure, mitigate, treat, or prevent any disease.” However as mentioned, it does have other good features for daily use, including quick fitness exercises subsequent heart rate monitoring and recording.

Usability

+-

Cardiio is easy to use and can detect your pulse with either your finger or the aforementioned great feature of looking into the screen to receive an accurate pulse reading. With its easily discernible layout, the app is great for daily use by those looking for quick exercising, endurance assessments and sharing results on social media platforms. It is not approved by the U.S. FDA as a health app for diagnosis, treatment or prevention of any kind, so its measurements and stats are for information purposes only. Not available for Androids.

Privacy & Security

+-

Though the app collects personal data, it ensures users that the tracing and pulses gathered are not tied to your personal data. Of course, users can easily transmit their own data to third parties such as Facebook. Once signed up with Cardiio, users may receive updates and new information about their website. Not password protected.

Reliability

+-

While the app provides the users with a gamut of features, the reliability is sound for pulse rate detection. Though it features a wave form detection, it doesn’t even try to give a rhythm assessment. The app includes a reliable and safe quick workout routine with somewhat of a trustworthy calorie counter and completely hypothetical life expectancy based on results.

Accessibility

+-

The basic app for detecting pulse is free and simple and cool to use. For the added features of fitness coaching and endurance assessments, the full package app costs $6.99 and features a quick seven- minute exercise program, though users may have to pay $2.99 for a voice in their language or dialect.

What Experts Say

Watch our interview with sport cardiologist Dr. Sunny Malhotra about atrial fibrillation.

References

  1. Tarakji KG, Wazni OM, Callahan T, Kanj M, Hakim AH, Wolski K, et al. Using a novel wireless system for monitoring patients after the atrial fibrillation ablation procedure: the iTransmit study. Heart rhythm. 2015;12(3):554-9.
  2. Freedman B. Screening for Atrial Fibrillation Using a Smartphone: Is There an App for That? Journal of the American Heart Association 2016;5
  3. Cardiio Inc. Research at Cardiio 2017 [cited 2017 Feb 9]. Available from: https://www.cardiio.com/research.
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