# EF vs EchoRef

The clearest difference is update cadence: EchoRef at every 2 months against EF's every 48 months. EF's advantage is device support (4 vs 2) and iOS requirement (12.0 vs 26.0). On price, ads and in-app purchases there is nothing between them.

Both are free to download. Neither carries in-app purchases, so what you see is what you pay.

EF ships an update every 48 months, EchoRef every 2 months. The most recent releases landed on October 1, 2026 and October 11, 2026 respectively.

## The numbers

| Metric | EF | EchoRef |
| --- | --- | --- |
| Price | Free | Free |
| Rating | — | **[4.9 (1.4K ratings)](https://appshunter.io/ios/app/echoref/id1434016053/reviews)** |
| Number of ratings | — | **1.4K** |
| Positive reviews | — | 100.0% of reviews |
| In-app purchases | No | No |
| Ads | No | No |
| Update frequency | Every 48 months | **Every 2 months** |
| Monetization | — | Free |
| Size | 22 MB | 105 MB |
| Requires iOS | **12.0** | 26.0 |
| Devices | **iPhone, iPad, iPod, Apple Watch** | iPhone, iPad |
| Age rating | 17+ | 17+ |
| Developer | [Keiji Matsui](https://appshunter.io/developer/365287272) | [Rishi Kumar](https://appshunter.io/developer/1434016052) |

## What reviewers say

### EF

[App page](https://appshunter.io/ios/app/ef-ejection-fraction/id1342185936)

**Features:** macOS Compatibility

**In-app purchases:** none


### EchoRef

[App page](https://appshunter.io/ios/app/echoref/id1434016053)

This educational reference app provides comprehensive information on point-of-care ultrasound (POCUS), echocardiography, and cardiac measurements. It includes lessons on interventional procedures and hemodynamic calculations for medical professionals.

**Highlights:** Point-of-care ultrasound (POCUS), Transthoracic echocardiography (TTE), Transesophageal echocardiography (TEE), Cardiac dimensions and valve measurements, Hemodynamic and ultrasound calculations, Interventional procedure lessons

**Features:** macOS Compatibility, Vision Pro support

**In-app purchases:** none


## Frequently asked questions

### Is EF free?

EF is free to download, with no in-app purchases.

### Is EchoRef free?

EchoRef is free to download, with no in-app purchases.

### Do EF or EchoRef have ads?

Neither EF nor EchoRef shows ads.

### Which is updated more often, EF or EchoRef?

EF ships an update every 48 months, and EchoRef every 2 months. Most recently, EF was updated on October 1, 2026 and EchoRef on October 11, 2026.

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*Compared by [AppsHunter](https://appshunter.io/) from daily US App Store data. Review summaries are generated from verbatim App Store reviews.*