Heart rate variability in cardiovascular disease diagnosis, prognosis and management

Heart rate variability (HRV), the variation in intervals between consecutive heartbeats, reflects autonomic nervous system function and has been studied as a potential biomarker in cardiovascular disease (CVD). While reduced HRV has been linked to arrhythmias, heart failure, and ischaemic heart disease, findings across studies are mixed and its prognostic value remains debated. This review evaluates HRV's diagnostic, prognostic, and therapeutic roles in CVD. HRV can reveal autonomic dysfunction early, predict outcomes such as sudden cardiac death and recurrent myocardial infarction, and track recovery after cardiac events. It also shows promise in monitoring comorbid conditions like heart failure and depression that exacerbate cardiovascular risk. Advancements in wearable technology and machine learning are expanding HRV's potential. Wearable devices enable continuous, non-invasive HRV monitoring, while machine learning algorithms enhance the precision and predictive power of HRV analysis. These innovations may facilitate real-time data collection and tailored treatment plans, though their clinical utility requires validation in larger, prospective trials. Key challenges remain, including measurement variability, lack of standardisation, and limited incremental prognostic value over established risk factors. This review highlights HRV's emerging role in personalised cardiovascular care while acknowledging the substantial research needed before widespread clinical adoption.