ArticleThe Journal of frailty & aging2025
Heart rate variability as a digital biomarker for frailty in cardiovascular patients.
Article in The Journal of frailty & aging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Interplay between frailty and cardiometabolic disorders: from pathophysiology to clinical implications.Cardiovascular diabetology · 2025Pooled it
- Resting Heart Rate Association with Cardiovascular Morbidity and Mortality and All-Cause Mortality According to Cluster of Cardiovascular Risk Factors-A Prospective Cohort Study with More than 20 Years of Follow-Up.Journal of clinical medicine · 2026Article
- Effects of remimazolam and propofol on parasympathetic activity during general anesthesia induction in patients with severe aortic stenosis: a randomized controlled trial utilizing high-frequency variability index.Journal of clinical monitoring and computing · 2026Article
- Exploring heart rate variability as a biomarker for frailty: A narrative review.European journal of clinical investigation · 2026Review
- The perioperative brain-heart-immune axis: autonomic resilience, multimodal monitoring and postoperative delirium.Frontiers in medicine · 2026Review
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Authors and funding
3 authors.
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Abstract
backgroundFrailty is a syndrome associated with age-related impairments in multiple organ systems, of which the autonomic nervous system plays a fundamental role. Measurement of heart rate variability (HRV) is a non-invasive method to evaluate the autonomic activity and gain insights into cardiovascular health and potentially, frailty. A few small studies have explored the relationship between HRV and frailty, with promising but conflicting results.
objectiveTo investigate the relationship between HRV and frailty among adult patients with cardiovascular disease.
designA cross-sectional study was conducted using clinical data.
settingData were collected from an ambulatory cardiology clinic.
participantsThe cohort comprised 155 patients with a mean age of 67 years (44 % female). MEASUREMENTS: HRV was assessed seated at rest for 2.5 min using a finger-based photoplethysmography (PPG) device. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score ≥5 considered frail. Associations between HRV and frailty were examined using a Spearman correlation matrix and multivariable ordinal regression model. The LF/HF ratio (a frequency-domain measure reflecting imbalances between sympathetic and parasympathetic activity) was the primary HRV measure analyzed.
resultsThe prevalence of frailty was 15 %. Among all HRV measures, the LF/HF ratio was most closely correlated with frailty (p < 0.001). In the multivariable model, each 1 standard deviation decrease in LF/HF ratio was associated with a 1.1-point increase in CFS (95 % CI 0.7-1.6, p < 0.001). The optimal ROC cutoff at which the LF/HF ratio was associated with frailty is ≤ 0.37.
conclusionsThe LF/HF ratio is inversely correlated with the CFS and independently associated with frailty. Measurement of HRV is a promising technique to enrich existing frailty scales and assist in frailty assessments in an ambulatory cardiology clinic.
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