Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses.
Open accessAbstract
Objective: To determine the prevalence and effect on traditional heart rate variability (HRV) indices of abnormal HRV patterns in the elderly. Methods: Hourly Poincaré plots and plots of spectral HRV from normal‐to‐normal interbeat intervals and hourly nonlinear HRV values were examined in a subset of 290 consecutive participants in the Cardiovascular Health Study. Only subjects in normal sinus rhythm with ≥18 hours of usable data were included. Eligible subjects were 71 ± 5 years. During 7 years of follow‐up, 21.7% had died. Hours were scored as normal (0), borderline (0.5), or abnormal (1) from a combination of plot appearance and HRV. Summed scores were normalized to 100% to create an abnormality score (ABN). Short‐term HRV versus each 5th percentile of ABN was plotted and a cutpoint for markedly increased HRV identified. The t ‐tests compared HRV for subjects above and below this cutpoint. Cox regression evaluated the association of ABN and mortality. Results: Of 5,815 eligible hourly plots, 64.4% were normal, 14.5% borderline, and 21.1% abnormal. HR, SDNN, SDNNIDX, ln VLF and LF power, and power law slope did not differ by the cutpoint for increased short‐term HRV, while SDANN and ln ULF power were significantly lower for those above the cutpoint. However, many HRV indices including LF/HF ratio and normalized LF and HF power were significantly different between groups (P < 0.001). Increased ABN was significantly associated with mortality (P = 0.019). Despite similar values for many HRV indices, being in the group above the cutpoint was significantly associated with mortality (P = 0.04). Conclusions: Abnormal HR patterns that elevate many HRV indices are prevalent among the elderly and associated with higher risk of mortality. Consideration of abnormal HRV may improve HRV‐based risk stratification.
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There are exceptions to the general rule that higher resting vagal tone is beneficial, for example when a higher resting vagal tone level is observed in eating disorders such as bulimia nervosa.
“There are some exceptions to this general rule (e.g., Stein et al., 2005; Peschel et al., 2016), for example when a higher resting vagal tone level is observed in the case of eating disorders such as bulimia nervosa (Peschel et al., 2016), which may be due to decreased resting metabolic rate originating from limited calorie intake (Martin et al., 2007).”
From Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research – Recommendations for Experiment Planning, Data Analysis, and Data Reporting (2017) · cites this paper as Stein et al., 2005
The Introduction and Discussion support Stein et al. as an example of why higher HRV is not always better: elevated HRV indices can reflect erratic rhythm rather than better autonomic function. The paper does not establish that higher resting vagal tone itself is harmful; the bulimia example is separately attributed to Peschel et al. in the citing sentence. (LLM, conf=0.84)
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Self-citation
- Authors
- STEIN, P. K., DOMITROVICH, P. P., HUI, N., RAUTAHARJU, P., & GOTTDIENER, J.
- Affiliations
- Washington University in St. Louis (US)
- Wake Forest University (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- STEIN, PHYLLIS K.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2005-08-31
- Volume
- 16
- Issue
- 9
- Pages
- 954-959
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2118573445
- Cited by
- 220
- References
- 22
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 15 · 2023: 13 · 2022: 9 · 2021: 8 · 2020: 20 · 2019: 15 · 2018: 14 · 2017: 14 · 2016: 3 · 2015: 10 · 2014: 6 · 2013: 9 · 2012: 10
- FWCI
- 5.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc085079-024, n01hc015103-009, n01hc085084-005, n01hc085085-011, n01hc085083-027, n01hc085080-026, n01hc085086-022, n01hc035129-010)
- National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01HC-85083, N01HC15103, N01HC85082, N01 HC85086, N01HC85080, R01 HL62181, R01HL062181, N01-HC85079, N01-HC85084, N01HC35129)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- heart rate variability, Poincaré plot, nonlinear HRV analysis, older adults, mortality risk, cardiovascular risk stratification, power-law slope, autonomic function
- MeSH terms
- Aged, Aged, 80 and over, Algorithms, Arrhythmia, Sinus, Diagnosis, Computer-Assisted, Electrocardiography, Female, Heart Rate, Humans, Male, Models, Cardiovascular, Numerical Analysis, Computer-Assisted, Risk Factors, Sensitivity and Specificity, United States, Reproducibility of Results, Cohort Studies, Prevalence, Proportional Hazards Models, Nonlinear Dynamics, Risk Assessment
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