Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Nov 14, 2025)
Date Submitted: Aug 4, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluating the Clinical Accuracy of Wearable HRV Devices in Inflammation Monitoring: A Systematic Review
ABSTRACT
Background:
Systemic inflammation is a key contributor to many chronic and acute diseases, yet its monitoring often requires invasive procedures. Heart rate variability (HRV), a non-invasive marker of autonomic nervous system function, has shown potential as a surrogate indicator of inflammation. With wearable devices now capable of continuous HRV monitoring, their clinical validity for inflammation detection requires systematic evaluation.
Objective:
This systematic review aims to evaluate the clinical accuracy of wearable devices in monitoring systemic inflammation by examining the association between heart rate variability (HRV) indices specifically SDNN and RMSSD and inflammatory biomarkers such as C-reactive protein (CRP), interleukins, and TNF-α across diverse inflammatory conditions. The goal is to assess the consistency and direction of associations and to explore the potential of wearable HRV monitoring as a non-invasive tool for inflammation detection.
Methods:
A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted (April 2025). Studies were eligible if they compared wearable-derived HRV parameters to inflammatory biomarkers (CRP, IL-6, IL-10, TNF-α). Risk of bias was assessed using QUADAS-2. Synthesis followed the SWiM guideline, employing vote counting and effect direction plots.
Results:
Eleven studies (n = 2,419) were included. Most studies found an inverse association between SDNN and CRP (83%; p = 0.031), while associations with cytokines (IL-6, IL-10, TNF-α) were inconsistent. RMSSD showed mixed results. Device type, recording duration, and population characteristics contributed to heterogeneity.
Conclusions:
Wearable-derived HRV, especially SDNN, shows promise as a non-invasive marker of systemic inflammation, particularly for CRP. However, further research is needed to establish clinical utility and standardize measurement protocols. Clinical Trial: PROSPERO registration number CRD420251029821
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