Key result
Heart rate variability predicts cardiovascular risk and mortality but lacks clinical validation from wearable devices.
Why the study?
Although heart rate variability is associated with a wide variety of diseases, comorbidities, and all-cause mortality, its clinical use is currently limited to the diagnosis of autonomic dysfunction amidst a recent increase in wearable devices that measure it.
This narrative review highlights that while decreased heart rate variability (HRV) is associated with cardiovascular disease and mortality, clinical implementation of HRV—especially from consumer wearables—remains limited by methodological inconsistencies, confounding physiological factors, and a need for further clinical validation.
Answers are grounded in this paper and cite their sources.
Caution against adopting wearable HRV for risk stratification; leaves open prospective validation in CVD cohorts.
Heart rate variability (HRV) measures time variability between heartbeats, is controlled by intricate and complex regulatory mechanisms, and generally reflects autonomic nervous system function. HRV is associated with a wide variety of diseases, comorbidities, and all-cause mortality. Clinically, its use is limited to the diagnosis of autonomic dysfunction. Recently, there has been an increased use of wearables which measure HRV, and they could be used clinically in the future if further studies are carried out, as argued in this review.
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Malmsiø et al. (2026) conducted a review in Cardiovascular disease and autonomic nervous system dysfunction. Heart rate variability (HRV) measurement was evaluated. Heart rate variability is a non-specific prognostic marker for cardiovascular disease and mortality that requires further clinical validation when measured by wearable devices.
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