Smartphone as an electronic stethoscope:factors influencing heart sound quality

AIMS: Smartphones are equipped with a high-quality microphone which may be used as an electronic stethoscope. We aim to investigate the factors influencing quality of heart sound recorded using a smartphone by non-medical users.METHODS AND RESULTS: An app named Echoes was developed for recording heart sounds using iPhone. Information on phone version and users' characteristics including sex, age, and body mass index (BMI) was collected. Heart sound quality was visually assessed and its relation to phone version and users' characteristics was analysed. A total of 1148 users contributed to 7597 heart sound recordings. Over 80% of users were able to make at least one good-quality recording. Good-, unsure- and bad-quality recordings amounted to 5647 (74.6%), 466 (6.2%) and 1457 (19.2%), respectively. Most good recordings were collected in the first three attempts of the users. Phone version did not significantly change the users' success rate of making a good recording, neither was sex in the first attempt (P = 0.41) or the first three attempts (P = 0.21). Success rate tended to decrease with age in the first attempt (P = 0.06) but not the first three attempts (P = 0.70). BMI did not significantly affect the heart sound quality in a single attempt (P = 0.73) or in three attempts (P = 0.14).CONCLUSION: Smartphone can be used by non-medical users to record heart sounds in good quality. Age may affect heart sound recording, but hardware, sex, and BMI do not alter the recording.