Continuous heart rate variability monitoring, stress and recovery in doctors: a systematic review and meta-analysis

Abstract

Background: burnout is a rising concern among doctors. Heart rate variability (HRV), a non-invasive measure of autonomic nervous system activity, can reflect physiological states of sympathetic (stress) and parasympathetic (recovery) nervous system activity.

Aims: this review aims to evaluate how continuous ambulatory HRV monitoring has been used to understand patterns of stress and recovery in doctors.

Methods: the study protocol was preregistered (PROSPERO CRD42023413282). A comprehensive search was conducted. Studies were eligible if they reported at least one HRV parameter combined with at least one contextual or psychological assessment over a 24-hour period in a doctor population. Methodological quality was assessed using the Joanna Briggs Institute risk of bias assessment for case reports and the Standard for Reporting Diagnostic Accuracy in HRV studies STARDHRV.

Results: we identified 805 records of which seven studies met the inclusion criteria. Meta-analysis was carried out for five different HRV parameters. Studies were conducted in seven different countries, ranged in participant numbers from 12 to 54 and each used a different HRV measurement device. There was a statistically significant difference in HRV between stress and recovery periods with four of these five parameters; root mean square of successive differences SMD = −0.63, P = 0.005, standard deviation of the NN (inter-beat) intervals SMD = −1.05, P = 0.001, low frequency (LF) Standard Mean Difference (SMD) = 0.54, P = 0.01, LF/high frequency (HF) SMD = 0.69, P = 0.006. The quality of studies was moderate at best.

Conclusions: continuous HRV monitoring may offer a viable method for tracking stress and recovery patterns that may contribute to burnout.

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ORCID for D. Powell: orcid.org/0000-0003-4995-6057

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