Heart Rate Variability Measured from Wearable Devices as a Marker of Disease Severity in Tetanus

Abstract

Tetanus is a disease associated with significant morbidity and mortality. Heart rate variability (HRV) is an objective clinical marker with potential value in tetanus. This study aimed to investigate the use of wearable devices to collect HRV data and the relationship between HRV and tetanus severity. Data were collected from 110 patients admitted to the intensive care unit in a tertiary hospital in Vietnam. HRV indices were calculated from 5-minute segments of 24-hour electrocardiogram recordings collected using wearable devices. HRV was found to be inversely related to disease severity. The standard deviation of NN intervals and interquartile range of RR intervals (IRRR) were significantly associated with the presence of muscle spasms; low frequency (LF) and high frequency (HF) indices were significantly associated with severe respiratory compromise; and the standard deviation of differences between adjacent NN intervals, root mean square of successive differences between normal heartbeats, LF to HF ratio, total frequency power, and IRRR, were significantly associated with autonomic nervous system dysfunction. The findings support the potential value of HRV as a marker for tetanus severity, identifying specific indices associated with clinical severity thresholds. Data were recorded using wearable devices, demonstrating this approach in resource-limited settings where most tetanus occurs.

Figure 1.

Correlation matrices of heart rate variability (HRV) indices. Correlation between HRV indices for (A) participants with and without muscle spasms, (B) with and without severe respiratory compromise, and (C) participants with and without autonomic nervous system dysfunction. Darker shading (red or blue) represents a greater correlation between the two indices. There is a high level of correlation between many of the indices in the dataset, justifying the use of the analysis of variance type II analysis.