journal articles
HEART RATE VARIABILITY AS A DIGITAL BIOMARKER FOR FRAILTY IN CARDIOVASCULAR PATIENTS
Maryia Samuel, Saleena Gul Arif, Jonathan Afilalo
J Frailty Aging 2025;14(1)
BACKGROUND: Frailty is a syndrome associated with age-related impairments in multiple organ systems, of which the autonomic nervous system plays a fundamental role. Measurement of heart rate variability (HRV) is a non-invasive method to evaluate the autonomic activity and gain insights into cardiovascular health and potentially, frailty. A few small studies have explored the relationship between HRV and frailty, with promising but conflicting results.
OBJECTIVE: To investigate the relationship between HRV and frailty among adult patients with cardiovascular disease.
DESIGN: A cross-sectional study was conducted using clinical data.
SETTING: Data were collected from an ambulatory cardiology clinic.
PARTICIPANTS: The cohort comprised 155 patients with a mean age of 67 years (44 % female).
MEASUREMENTS: HRV was assessed seated at rest for 2.5 min using a finger-based photoplethysmography (PPG) device. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score ≥5 considered frail. Associations between HRV and frailty were examined using a Spearman correlation matrix and multivariable ordinal regression model. The LF/HF ratio (a frequency-domain measure reflecting imbalances between sympathetic and parasympathetic activity) was the primary HRV measure analyzed.
RESULTS: The prevalence of frailty was 15 %. Among all HRV measures, the LF/HF ratio was most closely correlated with frailty (p < 0.001). In the multivariable model, each 1 standard deviation decrease in LF/HF ratio was associated with a 1.1-point increase in CFS (95 % CI 0.7–1.6, p < 0.001). The optimal ROC cutoff at which the LF/HF ratio was associated with frailty is ≤ 0.37.
CONCLUSIONS: The LF/HF ratio is inversely correlated with the CFS and independently associated with frailty. Measurement of HRV is a promising technique to enrich existing frailty scales and assist in frailty assessments in an ambulatory cardiology clinic.
CITATION:
Maryia Samuel ; Saleena Gul Arif ; Jonathan Afilalo (2025): Heart rate variability as a digital biomarker for frailty in cardiovascular patients. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2024.100007