Heart Rate Variability with Photoplethysmography in 8 Million Individuals: Results and Scaling Relations with Age, Gender, and Time of Day

Heart rate variability, or the variation in the time interval between consecutive beats, is a non-invasive dynamic metric of the autonomic nervous system and an independent risk factor for cardiovascular death. Prior limitations of use include requirements for continuous electrocardiography and lack of reference standards. Consumer wrist-worn tracking devices using photoplethysmography now provide the unique potential of continuously measuring surrogates of sympathetic and parasympathetic activity through the analysis of interbeat intervals. Here we leverage wrist-worn trackers to present the largest, to our knowledge, analysis of heart rate variability in humans across the time, frequency, and graphical domains. We derive diurnal parasympathetic and sympathetic measures and provide scaling parameters by age, sex, and time of day. Poincare plots graphically summarize heart rate variability metrics and may detect common arrhythmias. Lastly, we observe a strong dose-dependent correlation between daily steps and optimal heart rate variability metrics. Our results provide the ability to interpret continuous heart rate variability for tens of millions of wrist-worn trackers already in use.