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NPJ Digit Med. 2019 Jun 25;2:58. doi: 10.1038/s41746-019-0134-9. eCollection 2019.

Real-world heart rate norms in the Health eHeart study.

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1Division of Cardiology, Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco, Cardiology (San Francisco, CA, United States), 505 Parnassus Avenue, San Francisco, CA 94143 USA.
Azumio, inc (Palo Alto, CA, United States), 145, 255 Shoreline Drive, Redwood City, CA 94065 USA.
3Department of Epidemiology and Biostatistics, University of California San Francisco (San Francisco, CA, United States), 505 Parnassus Avenue, San Francisco, CA 94143 USA.


Emerging technology allows patients to measure and record their heart rate (HR) remotely by photoplethysmography (PPG) using smart devices like smartphones. However, the validity and expected distribution of such measurements are unclear, making it difficult for physicians to help patients interpret real-world, remote and on-demand HR measurements. Our goal was to validate HR-PPG, measured using a smartphone app, against HR-electrocardiogram (ECG) measurements and describe out-of-clinic, real-world, HR-PPG values according to age, demographics, body mass index, physical activity level, and disease. To validate the measurements, we obtained simultaneous HR-PPG and HR-ECG in 50 consecutive patients at our cardiology clinic. We then used data from participants enrolled in the Health eHeart cohort between 1 April 2014 and 30 April 2018 to derive real-world norms of HR-PPG according to demographics and medical conditions. HR-PPG and HR-ECG were highly correlated (Intraclass correlation = 0.90). A total of 66,788 Health eHeart Study participants contributed 3,144,332 HR-PPG measurements. The mean real-world HR was 79.1 bpm ± 14.5. The 95th percentile of real-world HR was ≤110 in individuals aged 18-45, ≤100 in those aged 45-60 and ≤95 bpm in individuals older than 60 years old. In multivariable linear regression, the number of medical conditions, female gender, increasing body mass index, and being Hispanic was associated with an increased HR, whereas increasing age was associated with a reduced HR. Our study provides the largest real-world norms for remotely obtained, real-world HR according to various strata and they may help physicians interpret and engage with patients presenting such data.


Epidemiology; Predictive markers

Conflict of interest statement

Competing interestsG.M. has received research funding from Medtronic and Cardiogram Inc, is a consultant for Lifewatch and InCarda, and holds equity in InCarda. P.K. is an employee of Azumio. There are no disclosures for the remaining authors. Azumio provided no financial support for this study and only provided access to the heart rate data. Data analysis and interpretation was performed independently from Azumio.

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