TY  - JOUR
AU  - Dhand, Amar
AU  - Mangipudi, Rama
AU  - Varshney, Anubodh S
AU  - Crowe, Jonathan R
AU  - Ford, Andria L
AU  - Sweitzer, Nancy K
AU  - Shin, Min
AU  - Tate, Samuel
AU  - Haddad, Haissam
AU  - Kelly, Michael E
AU  - Muller, James
AU  - Shavadia, Jay S
PY  - 2025
DA  - 2025/3/3
TI  - Assessment of the Sensitivity of a Smartphone App to Assist Patients in the Identification of Stroke and Myocardial Infarction: Cross-Sectional Study
JO  - JMIR Form Res
SP  - e60465
VL  - 9
KW  - time-to-treatment
KW  - digital health
KW  - patient-centered care
KW  - eHealth apps
KW  - smartphones
KW  - apps
KW  - cross-sectional study
KW  - stroke
KW  - myocardial infarction
KW  - heart attack
KW  - neurology
KW  - neurological assessment
KW  - accuracy
KW  - emergency department
KW  - finger-tapping test
KW  - hospital admission
KW  - physicians
KW  - medical records
KW  - mobile health
KW  - mhealth
KW  - symptom recognition
KW  - mobile phone
AB  - Background: Most people do not recognize symptoms of neurological and cardiac emergencies in a timely manner. This leads to delays in hospital arrival and reduced access to therapies that can open arteries. We created a smartphone app to help patients and families evaluate if symptoms may be high risk for stroke or heart attack (myocardial infarction, MI). The ECHAS (Emergency Call for Heart Attack and Stroke) app guides users to assess their risk through evidence-based questions and a test of weakness in one arm by evaluating finger-tapping on the smartphone. Objective: This study is an initial step in the accuracy evaluation of the app focused on sensitivity. We evaluated whether the app provides appropriate triage advice for patients with known stroke or MI symptoms in the Emergency Department. We designed this study to evaluate the sensitivity of the app, since the most dangerous output of the app would be failure to recognize the need for emergency evaluation. Specificity is also important, but the consequences of low specificity are less dangerous than those of low sensitivity. Methods: In this single-center cross-sectional study, we enrolled patients presenting with symptoms of possible stroke or MI. The ECHAS app assessment consisted of a series of evidence-based questions regarding symptoms and a test of finger-tapping speed and accuracy on the phone’s screen to detect unilateral arm weakness. The primary outcome was the sensitivity of the ECHAS app in detecting the need for ED evaluation. The secondary outcome was the sensitivity of the ECHAS app in detecting the need for hospital admission. Two independent and blinded board-certified physicians reviewed the medical record and adjudicated the appropriateness of the ED visit based on a 5-point score (ground truth). Finally, we asked patients semistructured questions about the app’s ease of use, drawbacks, and benefits. Results: We enrolled 202 patients (57 with stroke and 145 with MI). The ECHAS score was strongly correlated with the ground truth appropriateness score (Spearman correlation 0.41, P<.001). The ECHAS app had a sensitivity of 0.98 for identifying patients in whom ED evaluation was appropriate. The app had a sensitivity of 1.0 for identifying patients who were admitted to the hospital because of their ED evaluation. Patients completed an app session in an average of 111 (SD 60) seconds for the stroke pathway and 60 (SD 33) seconds for the MI pathway. Patients reported that the app was easy to use and valuable for personal emergency situations at home. Conclusions: The ECHAS app demonstrated a high sensitivity for the detection of patients who required emergency evaluation for symptoms of stroke or MI. This study supports the need for a study of specificity of the app, and then a prospective trial of the app in patients at increased risk of MI and stroke. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2025/1/e60465
UR  - https://doi.org/10.2196/60465
DO  - 10.2196/60465
ID  - info:doi/10.2196/60465
ER  -