Key result
Impaired heart rate variability is linked to ~99% higher mortality in heart failure patients.
Why the study?
Heart rate variability has been proposed as a prognostic tool in heart failure, but evidence regarding its predictive value for mortality remains fragmented.
Does measurement of heart rate variability predict mortality in adults with heart failure?
Meta-Analysis (n=10,544)
Does measurement of heart rate variability predict mortality in adults with heart failure?
Hazard Ratio: 1.99 (95% CI 1.36–2.61)
p-value: p=<0.001
Impaired heart rate variability, particularly reduced SDNN, is a robust predictor of mortality in heart failure patients across different ejection fraction phenotypes.
Impaired HRV predicts mortality in HF; supports risk stratification but leaves open standardization and prospective trials.
Heart rate variability (HRV), a marker of autonomic function, has been proposed as a prognostic tool in heart failure (HF), but evidence remains fragmented. This meta-analysis synthesizes data on HRV's predictive value for mortality in HF. Following PRISMA guidelines, PubMed, Embase, Cochrane, and other databases (2000-2024) were systematically searched for studies assessing HRV and mortality in HF. Ten studies (n = 10,544) were included, and random-effects meta-analyses were conducted. The pooled effect size (ES) for the HRV-mortality association was significant (ES = 1.99, 95% CI: 1.36-2.61, p < 0.001), with time-domain measures (standard deviation of NN intervals (SDNN)) showing the strongest prediction (ES = 1.75, I² = 71.49%). Subgroup analyses revealed consistent effects in heart failure with reduced ejection fraction (HFrEF) (ES = 1.74) and mixed populations (ES = 1.99), though heterogeneity was high (I² = 97.67%). HRV improved risk stratification beyond ejection fraction and New York Heart Association (NYHA) class, particularly for sudden death (hazard ratio (HR): 2.1-3.2). Impaired HRV is a robust mortality predictor in HF, with SDNN being the most reliable parameter. Standardization and HRV-guided therapy trials are needed to enhance clinical utility.
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A 2025 study conducted a meta-analysis in Heart Failure (n=10,544). Impaired heart rate variability vs. Preserved heart rate variability was evaluated on All-cause or cardiovascular mortality (HR 1.99, 95% CI 1.36-2.61, p=<0.001). Impaired heart rate variability was significantly associated with increased mortality in patients with heart failure (pooled HR 1.99).
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