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June 29, 2021Journal of Occupational Medicine and ToxicologyOpen Access

Heart rate variability as a strain indicator for psychological stress for emergency physicians during work and alert intervention: a systematic review

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Key result

Alert interventions and shift work were associated with a decrease in parasympathetic-mediated heart rate variability parameters, indicating increased psychological stress among emergency physicians.

Why the study?

Emergency physicians face severe workloads and higher burnout prevalence, warranting systematic evaluation of heart rate variability as an objective indicator for mental stress.

Does alert intervention and shift work reduce heart rate variability in emergency physicians?

Design

Systematic literature review

Authors

BTBeatrice ThielmannUniversity Children's Hospital TübingenRPRobert PohlOtto-von-Guericke University MagdeburgIBIrina BöckelmannORCID

Discussion

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Implication

May prompt caution with alert systems and shift scheduling in emergency medicine; supports HRV as objective marker for occupational stress studies.

Study Design

Type

Systematic Review (n=96)

Structured PICO

Does alert intervention and shift work reduce heart rate variability in emergency physicians?

P
Population
96 emergency physicians across 4 studies evaluating heart rate variability as an objective indicator of mental stress during shift work and alert interventions.
E
Exposure
Alert intervention, emergency operations, or shift work (14-hour or 24-hour shifts)
C
Comparator
Control day (clerical day without patient contact) or pre-alert period
O
Outcome
Heart rate variability (HRV) parameters (e.g., RMSSD, SDNN, LF/HF) measured via Holter ECG or chest beltsurrogate

Heart rate variability, particularly parasympathetic-mediated parameters like RMSSD, decreases during emergency operations, indicating it is a suitable objective marker for psychological stress in emergency physicians.

Limitations

  • Small number of included studies and low subject numbers
  • Different study protocols and recording times limit comparability
  • Lack of methodological quality and quality of study reports
  • Potential for movement artifacts during monitoring
  • Inconsistent use of non-linear parameters across studies
  • Small number of cases and studies
  • Different study protocols and recording times limiting comparability
  • Lack of methodological quality in some studies

Cite This Study

Thielmann et al. (2021) conducted a systematic review in Psychological stress and workload (n=96). Alert interventions and shift work vs. Control day, pre-alert period, or clerical day was evaluated on Heart rate variability (HRV) parameters (e.g., RMSSD, SDNN). Alert interventions and shift work were associated with a decrease in parasympathetic-mediated heart rate variability parameters, indicating increased psychological stress among emergency physicians.

synapsesocial.com/papers/6a20d991920f77b2c049cfd8https://doi.org/10.1186/s12995-021-00313-3
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The validity of linear and non-linear heart rate metrics as workload indicators of emergency physicians2017 · 26 citations
  2. 2First Evaluation of an Index of Low Vagally-Mediated Heart Rate Variability as a Marker of Health Risks in Human Adults: Proof of Concept2019 · 86 citations
  3. 3Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): recommendations to advance research communication2016 · 435 citations
  4. 4Adverse health effects of high-effort/low-reward conditions.1996 · 4,101 citations
  5. 5Occupational stress, burnout and personality in anesthesiologists2018 · 71 citations