Factors influencing heart rate variability

The measurement and analysis of heart rate variability (HRV), which is based on the variation between consecutive NN intervals, has become an established procedure over the past two decades. A decrease in HRV has been shown to correlate with an increase in mortality. HRV is influenced by a number of physiological factors such as various diseases. Awareness of these mediators or confounders is of great importance in the analysis and assessment of HRV both in scientific studies and in clinical practice. This document, which is based on a selective survey of references and supplemented by information from national and international guidelines, presents the main endogenous, exogenous and constitutional factors. A decrease in HRV has been observed not only in connection with non-influenceable physiological factors such as age, gender and ethnic origin, but also in conjunction with a large number of acute and chronic diseases. Numerous lifestyle factors have both a positive and a negative influence on HRV. There are also physical influences that affect HRV. They must on no account be disregarded. Although the list of the factors is long and not all of them have yet been fully studied, awareness of them is of crucial importance in the measurement of HRV (both under laboratory conditions and during medical practice), its analysis and its assessment. More research also needs to be carried out to close knowledge gaps.