Development and uptake of the National Heart Foundation of Australia Smart Heart Guideline App (Preprint)

BACKGROUND Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile applications (apps) for real-time use in clinical practice. The National Heart Foundation of Australia publish three key cardiac clinical guidelines in collaboration with the Cardiac Society of Australia and New Zealand including: 1) the Australian clinical guidelines for the prevention and detection of atrial fibrillation; 2) the Australian clinical guidelines for the detection and management of heart failure ; and 3) the Australian clinical guidelines for the management of acute coronary syndromes. To improve access and uptake for healthcare providers we developed the Smart Heart Guideline App OBJECTIVE To understand the need for, develop and evaluate the uptake of an Australian-specific mobile app to improve access and uptake of three national cardiac clinical guidelines. METHODS We used an iterative mixed methods approach, an established method in mobile app development and evaluation. First, we conducted an online survey of end-users in 2017 to determine the need and acceptability of an Australian-specific mobile app to access cardiac clinical guidelines. Second, we engaged a software developer to create the Smart Heart Guidelines App using a process of design, testing and revision, which included user testing. The app was registered with the regulatory body in Australia, the Therapeutic Goods Administration, and made freely available from October 2019 on iOS and Android operating systems and promoted using multiple methods. Third, data from the app stores was analyzed between 1 October 2019 – 1 October 2020 to evaluate the app’s uptake and performance. Fourth, data from two annual national General Practitioner (GP) surveys in 2019 and 2020 were analyzed to assess awareness and use of the clinical guidelines and the app. RESULTS Most health professionals surveyed (89%; n=447/504) reported accessing resources electronically and most (70%) reported they would use an Australian-specific cardiac guidelines app. The app was downloaded 11 313 times (66%; n=7483 from Apple App Store; 34%; n=3,830 from Google Play) during the first 20-month period. Most downloads (84%; n=6300) were a result of searching for the app in the stores. Apple App Store data indicated over 59900 impressions (the number of times the app appeared in a search) and 9000 product page views (number of times a user viewed the apps product page). Monthly downloads rates varied. Many (85%) Android users deleted the app. CONCLUSIONS Health professionals supported the development of the Smart Heart Guidelines App. The number of app store searches and total downloads indicate initial promotion of the app was effective. Further evaluation of users’ experience is needed.