ArticleEuropean heart journal. Digital health2026
The clinical value of circadian biofeedback in chronic heart failure.
Article in European heart journal. Digital health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Chronic heart failure (CHF) is characterized by impaired autonomic regulation and disrupted sleep-wake cycles, limiting recovery and daily function. CircAlign-HF, a wearable-guided circadian biofeedback tool providing personalized timing recommendations on activity, naps, and sleep, was developed. This study evaluated its physiological and clinical value in CHF. Methods and results: Twenty-one patients with stable CHF (median age 68 years, 90.5% male, NYHA II-III) completed a 3-week crossover protocol. Week 1 served as baseline, in Week 2 participants received general advice (30 min daily walk, 20 min nap, sleep hygiene), and in Week 3, participants were guided to align their walk, nap, sleep, and wake times with their circadian rhythm. Autonomic regulation was assessed using HRV over 24 h, and within 15 min windows centred on each participant's peak daytime activity (diurnal acrophase) and deepest nocturnal rest (nocturnal nadir), capturing activity-related and sleep-related autonomic function. Patient-centred outcomes and adherence were evaluated using a structured questionnaire.General advice improved 24 h autonomic regulation: the root mean square of successive differences (rMSSD) increased from baseline to Week 2 (+18.2 ms, Conclusion: General advice improved overall autonomic regulation, whereas circadian-aligned recommendations specifically enhanced nocturnal autonomic function. These short-term physiological and perceived gains support the potential relevance of circadian biofeedback as a behavioural strategy in chronic heart failure.
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