Resting Heart Rate and Associations with Clinical Measures from the Project Baseline Health Study: An Observational Study (Preprint)

BACKGROUND Though widely used, resting heart rate (RHR) as measured by a wearable device has not been previously evaluated in a large cohort against a variety of important baseline characteristics. OBJECTIVE This study aimed to assess the validity of the RHR measured by a wearable device compared against the gold standard of ECG, and assess the relationships between device-measured RHR and a broad range of clinical characteristics. METHODS The Project Baseline Health Study (PHBS) captured detailed demographic, occupational, social, lifestyle, and clinical data to generate a deeply phenotyped cohort. We selected an analysis cohort within it, which included participants who had RHR determined by both electrocardiogram (ECG) and by the Verily Study Watch (VSW). We examined the correlation between these simultaneous RHR measures, and assessed the relationship between VSW RHR and a range of baseline characteristics including demographic, clinical, laboratory, and functional assessments. RESULTS From the overall PBHS cohort (N=2502), 875 (35%) participants entered the analysis cohort, 519 (59%) female and 356 (41%) male participants. The mean and standard deviation of VSW RHR was 66.6 ± 11.2 beats per minute (bpm) for female participants, and 64.4 ± 12.3 bpm for male participants. There was excellent reliability between the two measures of RHR (ECG and VSW) with an intraclass correlation coefficient of 0.946. By univariate analyses, female and male participants had similar baseline characteristics that trended with higher VSW RHR: lack of healthcare insurance (both p <0.05), higher BMI (both p<0.0001), higher C-reactive protein (both p<0.0001), presence of type 2 diabetes mellitus (both p<0.0001), and higher World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score (both p<0.0001) were associated with higher RHR. By regression analyses, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female compared to male participants: demographics and socioeconomic status (unemployment vs. lack of health insurance), medical conditions (chronic obstructive pulmonary disease with emphysema vs. type 2 diabetes mellitus), laboratory assessments (C-reactive protein vs. blood glucose), and patient reported outcomes (eWHO Disability Assessment Schedule 2.0 score vs. Behavior Risk Factor Surveillance System score). Diastolic blood pressure was the most associated characteristic with higher VSW RHR for both sexes within the vitals and physical function domain. CONCLUSIONS RHR determined by the VSW had excellent correlation with RHR determined by ECG. Participants with higher VSW RHR had similar trends in socioeconomic status, medical conditions, vitals, laboratory assessments, physical function, and patient reported outcomes irrespective of sex. However, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female versus male participants. CLINICALTRIAL clinicaltrials.gov identifier NCT03154346