Heart rate variability of interventional cardiology fellows and attendings and changes over time

The levels of stress experienced by interventional cardiologists (IC) while performing procedures are not well known. The study examined the IC fellow and attending stress levels using both objective (heart rate variability [HRV]) and subjective (State Trait Anxiety Inventory [STAI]) metrics across the IC fellowship.

Six ICs participated in a study conducted over 2 periods, each lasting 10 to 14 days. Participants recorded their HRV using a Polar H10 chest strap (Polar Electro, Inc.) and a WHOOP 4.0 wrist band (WHOOP). The low frequency/high frequency (LF/HF) ratio, biomarker of sympathetic system activation, and related metrics were calculated using Kubios HRV Scientific software (Kubios Oy).

A total of 217 procedures were analyzed. The median LF/HF ratio during procedures was significantly higher than at baseline (6.2 vs 4.1, P less than .001). Complex procedures had higher LF/HF ratio difference (procedural minus baseline LH/HF ratio) compared with non-complex procedures (2.55 vs 1.73, P less than .001), as did procedures with complications compared with uncomplicated procedures (3.01 vs 1.82, P less than .001) and emergent compared with non-emergent (3.51 vs 1.84, P less than .001) procedures. Procedures performed during period 2 (end of IC fellowship) had a lower LF/HF ratio difference (2.96 vs 1.10, P less than .001) but higher daily resting HRV (52 vs 46, P less than .001) compared with period 1 (beginning of IC fellowship). No correlation was detected between the pre- and post-procedural LF/HF ratio difference and the STAI score difference.

Interventional cardiologists experience significant stress, as measured by the LF/HF ratio, during complex, emergency, and complicated procedures; however, stress levels decrease later in the IC fellowship.