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

Ho Bich Hai Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;

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Jonathan W. S. Cattrall Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;
Department of Psychiatry, University of Oxford, United Kingdom;

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Nguyen Van Hao Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;
University Medicine and Pharmacy, Ho Chi Minh City, Vietnam;

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Hoang Minh Tu Van Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;

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Duong Bich Thuy Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;

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Phung Tran Huy Nhat Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;

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Phan Nguyen Quoc Khanh Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;

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Ha Thi Hai Duong Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;
Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom;

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Tran Duc Duong Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;

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Ping Lu Institute of Biomedical Engineering, University of Oxford, United Kingdom

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Le Thanh Phuong Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;

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Heloise Greeff Institute of Biomedical Engineering, University of Oxford, United Kingdom

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Tingting Zhu Institute of Biomedical Engineering, University of Oxford, United Kingdom

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Lam Minh Yen Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;

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David Clifton Institute of Biomedical Engineering, University of Oxford, United Kingdom

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C. Louise Thwaites Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;
Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom;

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on behalf of the VITAL consortium
DOI:
https://doi.org/10.4269/ajtmh.23-0531
Volume/Issue:
Ahead of Print
Open access
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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.

Author Notes

Financial support: This work was supported by the Wellcome Trust (grant no. 107367/Z/15/Z CLT) and VITAL (215010/Z/18/Z). J. C. was supported by travel funding from Brasenose College, University of Oxford, and the MSc in Clinical and Therapeutic Neuroscience, University of Oxford, United Kingdom. J. C. was also supported by the Rosemary Maguire Educational Bursary from Parkinson’s UK. The funding sources had no involvement in the design of the study. D. A. C. is funded by a Royal Academy of Engineering Research Chair, a National Institute of Health Research (NIHR) Research Professorship, the NIHR Oxford Biomedical Research Centre, the InnoHK Centre for Cerebro-cardiovascular Engineering, and the Pandemic Sciences Institute at Oxford University.

Authors’ addresses: Ho Bich Hai, Hoang Minh Tu Van, Phung Tran Huy Nhat, Phan Nguyen Quoc Khanh, Le Thanh Phuong, and Lam Minh Yen, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, E-mails: haihb@oucru.org, drvanhoang@gmail.com, nhatpth@oucru.org, khanhpnq@oucru.org, phuonglt@oucru.org, and yenlm@oucru.org. Jonathan W. S. Cattrall, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and Department of Psychiatry, University of Oxford, United Kingdom, E-mail: jwscattrall@doctors.org.uk. Nguyen Van Hao, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, and University Medicine and Pharmacy Ho Chi Minh City, Vietnam, E-mail: dr_nguyenvanhao@ump.edu.vn. Duong Bich Thuy and Tran Duc Duong, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, E-mails: duongthuyaicu@gmail.com and duongtran.bvbnd@gmail.com. Ha Thi Hai Duong, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, and Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom, E-mail: duonghth@oucru.org. Ping Lu, Heloise Greeff, Tingting Zhu, and David Clifton, Institute of Biomedical Engineering, University of Oxford, United Kingdom, E-mails: ping.lu@wolfson.ox.ac.uk, heloisegreeff@gmail.com, tingting.zhu@eng.ox.ac.uk, and david.clifton@eng.ox.ac.uk. C. Louise Thwaites, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom, E-mail: lthwaites@oucru.org.

Address correspondence to Ho Bich Hai, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam. E-mail: haihb@oucru.org
Copyright:
© The author(s) 2023
Received:
10 Aug 2023
|
Accepted:
17 Sep 2023
|
Published Online:
20 Nov 2023
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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