Evaluating HeartWise Blood Pressure Tracker app as ambulatory monitoring tool for patients

Evidence Based Patient Centric App Review Series
App Reviewed: HeartWise Blood Pressure Tracker for iPad (ver. 3.5.1)
Last Updated: June 8, 2010
Compatibility: iPad
Requires: iOS 3.2 or later
Language Support: English, Spanish, German
Reviewed on: iPad 2
*Note: HeartWise Blood Pressure Tracker exist for the iPhone and iPod, but as a different application which is not reviewed here
Goals of app review:

• To determine whether HeartWise Blood Pressure Tracker has the applicability to be utilized by patients for recording their blood pressure in the ambulatory setting
• To evaluate the integration of HeartWise Blood Pressure Tracker as a tool for therapeutic decision making for healthcare

Introduction:
Blood Pressure (BP) management is key depending on comorbidities. The 7th Joint National Commission (JNC7) has created guidelines for blood pressure goals for patients. These include patients with chronic kidney disease, diabetes, history of stroke, or coronary artery disease. It is recognized that control of blood pressure in these patients can help reduce morbidity and mortality.
HeartWise Blood Pressure Tracker is a monitoring tool developed by SwEng. L.L.C. to help monitor patients BP in a visual manner that can be communicated to healthcare providers. The app was designed for users to input data to visually display their BP levels over a period of time.
App Specifics:
The app opens up to a home screen where the user is able to input data. This includes the systolic and diastolic BP, heart rate (HR), and weight. The data utilized will be entered into the log as the current time used, unless adjusted.
Additionally, the user may also include notes on the data entered (eg. post-exercise, pre-or-post position changes)


After the user inputs their personal data into the app, it is displayed in chart format. This can be accessed at the bottom option bar of the app with ‘Charts’ or ‘Detailed Statistics.’ The chart option allows the users data to be displayed by week/month/year. Included in this chart is blood pressure, heart rate, and weight/BMI. Selecting any data point shows the time and date of the input, along with associated key measurements. For instance, selection of a blood pressure will also show a calculated mean arterial pressure (MAP) and pulse pressure (PP).**

The detailed statistics options brings up a similar visualized chart of the patients BP as trended over week/month/year. However, this chart also can display range and warning lines of the BP as trended by the app. This may be beneficial to visualize at what time of day the patient may be out of goal range or at risk for hypotension. Below the chart is a chart showing min/max of data, along with the averages of current values.

One last major chart that can be brought up is the log chart of data entered. This can be accessed by double-tapping a table under the chart option. For instance, double-tapping the BP chart will bring up a detailed chart and log of the user’s inputted BP. This is the only area where a user may edit entered data from earlier.

After data has been entered, the user may export the data to a healthcare professional or keep the record for later use. This is available under the ‘Export & Email Data’ option. Each visual chart has an option to capture the current screen, which is then stored in the user’s photos. In addition, a formatted or raw data report can be emailed as well.


Lastly, the app has multiple help options available on the screen to help the user understand how to enter the data and what the charts/graphs mean. This is beneficial for users who may have some confusion upon initial utilization.


**The calculated MAP, PP, and BMI were spot checked in order to verify accuracy of data presented via the app. All calculations performed matched with data entered, however, data appears to be rounded to nearest lowest whole number.

Healthcare Goals:

HeartWise Blood Pressure Tracker aims to create a tool to visually measure a patient’s blood pressure and establish trends with their healthcare provider. Through its use, a provider may be able to make therapeutic alterations to therapy based on patients own personal data taken at home.

Evidence to Support Goals:

Currently there is limited data supporting the use of mobile app technology and management of BP in the ambulatory setting. Many studies conducted have evaluated the perceptions of patients in the utilization of mobile app technology in self-management [1,2]. These studies have demonstrated patients are willing to engage with remote self-monitoring through mobile technology with their caretakers.
One study was identified using mobile technology for outpatient management of chronic diseases that also included BP control. The study was conducted in South Korea by Park MJ et al that evaluated the utilization of mobile phones in managing BP in obese patients in the ambulatory setting [3]. The results of the study found that a decrease in BP and weight in the intervention group through the close communication provided between patient and provider, based upon patient recorded data sent to their provider.
What must be mentioned is that this review looked for integration of mobile technology for BP management, and did not include home telemedicine, which has already been demonstrated to be beneficial in chronic BP management. This adds credence to the utilization of mobile app technology to also accomplish the same goal, based on the similar principles.
However, more outcome data is needed for integration of mobile apps for personal-data recording and communication with practitioners to make therapeutic adjustments [4].

Price:

• $2.99 – iPad Application
• $0.99 – iPhone Application

Likes:

• App is easy to use with a simple UI for data input
• Instructions are easily accessed for user to understand data displayed
• Data entered is presented visually appealing and easy to read and utilize
• Ability to trend data over week/month/year

Dislikes:

• Currently app is not available cross-devices
• Editing data takes some work
• The app has a hard time shifting between landscape and portrait view
• App has not been updated since 2010

What type of provider would benefit from this app?

• Primary Care Physician
• Cardiologist
• Blood Pressure Management Clinic

What type of patient would benefit from this app?

• Patients that require close monitoring of BP
• Patients that can input personal data daily
• Patients that have a blood pressure monitoring device

Conclusions:

• HeartWise Blood Pressure Tracker is a easy to utilize app that may help monitor and manage BP in the ambulatory setting
• This app may be beneficial for patients who can easily monitor their BP and require close monitoring due to complications of comorbidities
• Pros – easy to utilize app for those familiar to mobile technology applications and is accessible by both patients and practitioners
• Cons – Cost may off put some patients and ability to routinely monitor and input data may also be a deterrent

Bottom Line:

Clinicians who need to monitor patients BP in the ambulatory setting and can rely on their patients to record their data continuously may benefit from integration of HeartWise Blood Pressure Tracker into care. The ability to record and transmit patients data and visualize trends in BP control may be beneficial in making therapeutic adjustments in therapy.
iTunes Link

References:

1. Logan Ag, McIsaac WJ, Tisler A, Irvine MJ, et al. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.Am J Hypertens. 2007 Sep;20(9):942-8.
2. Wakefield BJ, Holman JE, Ray A, Scherubel M.Patient perceptions of a remote monitoring intervention for chronic disease management.J Gerontol Nurs. 2011 Apr;37(4):16-20.
3. Park MJ, Kim HS, Kim KS.Cellular phone and Internet-based individual intervention on blood pressure and obesity in obese patients with hypertension.Int J Med Inform. 2009 Oct;78(10):704-10.
4. Bosworth HB, Powers BJ, Oddone EZ.Patient self-management support: novel strategies in hypertension and heart disease.Cardiol Clin. 2010 Nov;28(4):655-63.

Disclaimer:
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.