Cited by 117Heart Rate Variability and Autonomic ControlCardiac Health and Mental HealthHeart rate and cardiovascular health

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Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review

Nolan, Robert P., Jong, Philip, Barry-Bianchi, Susan M., Tanaka, Tim H., Floras, John S.·2008·European Journal of Cardiovascular Prevention & Rehabilitation

DOI 10.1097/hjr.0b013e3283030a97

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Abstract

BACKGROUND: Heart rate variability (HRV) is reported as a surrogate index for clinical outcome in trials of secondary prevention strategies for coronary artery disease (CAD), but a standardized guide for interpreting HRV change is not established. DESIGN: We evaluated HRV change in trials with CAD patients who received conventional medications (beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors), biobehavioral treatment (psychotropics, biofeedback, relaxation) or exercise training. METHODS: Medline, Pubmed, Psycinfo, the Cochrane database, and Embase were searched until July 2007, without language restriction. We identified 33 randomized controlled trials. Two reviewers independently abstracted all trials using a standardized form. A hierarchy of frequency and time domain HRV indices defined outcome. RESULTS: A random-effects model yielded an overall pooled standardized mean difference (SMD) between treatment and control groups of moderate magnitude across treatment classes, based on a composite of time and frequency domain indices (SMD=0.40, P<0.0001), or only time or frequency indices (SMD=0.37 and 0.43, respectively, both P<0.0001). This change was equivalent to an increase in standard deviation of all normal-to-normal RR intervals of 9.0 ms (95% Confidence Interval, CI, 7.3, 10.7 ms) or a relative increase of 15.9% (95% CI, 13.2, 18.6%). To detect HRV change of this magnitude, a hypothetical trial would require a sample size of 660 patients for conventional medications or 1232 patients for all treatment classes. CONCLUSION: Pharmacologic, biobehavioral and exercise strategies for secondary prevention of CAD significantly increase HRV. This review provides a framework to assist efforts to evaluate the contribution of HRV change to CAD prognosis.

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Authors: Nolan, R. P., Jong, P., Barry-Bianchi, S. M., Tanaka, T. H., & Floras, J. S.
Affiliations: University Health Network (CA)
Tsukuba University of Technology (JP)
Corresponding author: Nolan, Robert P.
ORCID: Nolan, Robert P.
Floras, John S.
Venue: European Journal of Cardiovascular Prevention & Rehabilitation
Publisher: Oxford University Press (OUP)
Published: 2008-08
Volume: 15
Issue: 4
Pages: 386-396
ISSN: 1741-8267 (ISSN-L)
DOI: 10.1097/hjr.0b013e3283030a97
OpenAlex: W2055655271
Cited by: 117
References: 49
Citations by year: 2026: 3 · 2025: 1 · 2024: 7 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 12 · 2019: 6 · 2018: 5 · 2017: 8 · 2016: 5 · 2015: 6 · 2014: 14 · 2013: 8 · 2012: 8
FWCI: 1.11
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: European Journal of Cardiovascular Prevention & Rehabilitation (publishedVersion)
PubMed (publishedVersion)
Funders: Heart and Stroke Foundation of Canada
Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
Keywords: heart rate variability, coronary artery disease, secondary prevention, beta-blockers, calcium channel blockers, ACE inhibitors, psychotropic drugs, biofeedback, relaxation training, exercise training, time-domain HRV, frequency-domain HRV indices, sample size determination, surrogate endpoints
MeSH terms: Behavior Therapy, Cardiovascular Agents, Coronary Artery Disease, Exercise Therapy, Heart Rate, Humans, Randomized Controlled Trials as Topic

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Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review

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