Fabian Chavez-Ecos ^1,2 Rodrigo Chavez-Ecos ¹ Carlos Vergara Sanchez ³ Miguel Chavez Gutarra ⁴ Anandita Agarwala ⁵ Kiara Camacho-Caballero ^1*

• ¹ CHANGE Research Working Group, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
• ² Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
• ³ Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, United States
• ⁴ Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga, Ica, Peru
• ⁵ Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Texas, United States

Introduction: mHealth apps (MHA) are emerging as promising tools for cardiovascular risk assessment, but few meet the standards required for clinical use. We aim to evaluate the quality and functionality of mHealth apps for cardiovascular risk assessment by healthcare professionals. Methods: We conducted a systematic review of MHA for cardiovascular risk assessment in the Apple Store, Play Store, and Microsoft Store until August 2023. Our eligibility criteria were based on the 2021 European Society Cardiology Guidelines on Cardiovascular Disease Prevention in Clinical Practice, the Framingham Risk Score, and the Atherosclerotic Cardiovascular Disease score. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. To assess quality, we used the validated Mobile Apps Rating Scale (MARS) score, which includes 19 items across four objective scales (engagement, functionality, aesthetics, and information quality) and one additional subjective scale. For functionality evaluation, we used the IMS Institute for Healthcare Informatics functionality scale. We performed data synthesis by generating descriptive statistics. Results: A total of 18 MHA were included in the review. The most common scores used were the Framingham score, ASCVD score, and Score 2. Only six apps achieved an overall score of 4 or greater in the MARS evaluation. The MHA with the highest MARS score was ESC CVD Risk Calculation (5 points), followed by ASCVD Risk Estimator Plus (4.9 points). In the IMS scale, four MHA had a high functionality score: ASCVD Risk Estimator Plus (5 points), ESC CVD Risk Calculation (5 points), MDCalc Medical Calculator (4 points), and Calculate by QsMD (4 points). Discussion: A gap exists in the availability of high-quality MHA designed for healthcare professionals to facilitate shared decision-making in cardiovascular risk assessment.