> For the complete documentation index, see [llms.txt](https://docs.bitdoctor.ai/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.bitdoctor.ai/clinical-measurement-reports/heart-rate.md).
# Heart Rate
## Description
Heart rate (HR) is the number of times the userโs heart beats, expressed as a rate per minute. A bpm of 60-100 is considered healthy/normal.
## Participants
Subjects were recruited from Affiliated Hospitals. There were no exclusion criteria when recruiting participants, although most participants were healthy adults above 18 years of age. Table 1 summarizes participant characteristics.
| Participants | Composition |
| ------------------------- | -------------------- |
| Average Age | 41.2 years |
| Standard deviation of age | 15.2 years |
| Gender distribution | 48% Male; 52% Female |
*Table 1: Characteristics of participants for HR and MSI*
## Additional Data Collection Setup
Reference heartbeat information was collected with a 3-lead electrocardiograph (ECG). The data collection setup is depicted in Figure 1.
*Figure 1: HR, Mental Stress Index & Irregular Heartbeat data collection setup*
## Analysis of Accuracy & Reliability
Heartbeats were then identified in both ECG signal (reference signal) and BitDoctor signal (test signal).
ECG captures heartbeats as characteristic fluctuations in the heartโs electrical signal that occur with each beat (Figure 2). The major peak in this fluctuation (R-wave) was used to identify each heartbeat on the ECG trace. The heart rate is calculated by counting the number of heartbeats on a given trace (Figure 3) and expressing this number as a per minute rate.
Figure 2: Labeled ECG wave.
Figure 3: ECG recording used for heart rate computation.
This signal robustly tracks the activity of the heart in terms of number of beats and inter-beat timing (Figure 4). Like ECG, BitDoctor heart rate was calculated from each participantโs blood flow information.
*Figure 4. Comparison between ECG heart rate and BitDoctor HR. BitDoctor signal trace (red) is overlaid on an ECG trace (blue) from a healthy adult.*
The accuracy of BitDoctor-based measurements relative to ECG-based measurements was then calculated, considering only measurements with a positive signal-to-noise ratio.
Equation 1: Calculation of BitDoctor heart rate accuracy.
HR accuracy was calculated as: (1 โ 1 ๐ โ | *BITDOCTOR* ๐ป๐ โ ๐ธ๐ถ๐บ ๐ป๐ ๐ธ๐ถ๐บ ๐ป๐ |) ร 100%
### Results
The accuracy and reliability of BitDoctor-based HR is presented in Table 2. Reliability refers to the test-retest reliability of each item.
| Physiological Measure | Accuracy (%) | Reliability (%) |
| :-------------------: | :----------: | :-------------: |
| HR | 99 | 100 |
*Table 2: Accuracy and reliability of BitDoctor HR*
## HR Accuracy Details
Table 3 presents additional accuracy metrics pertaining to HR.
| | HR Accuracy (bpm) |
| :-------------------------: | :---------------: |
| Mean ECG HR | 74.4 |
| Mean BitDoctor HR | 75.1 |
| Mean Error | 0.63 |
| Standard Deviation of Error | 1.21 |
| Mean of Absolute Error | 0.79 |
*Table 3: Additional BitDoctor heart rate accuracy metrics*
Additional analysis was conducted to determine BitDoctor-based HR accuracy with shorter (30-second) measurements. Once again, BitDoctor-based HR tracked reference (ECG) HR very well (Figure 5). The Pearson correlation between ECG and BitDoctor measurements under these conditions was essentially perfect (r=1.0).
*Figure 5: Scatter plot of 30-second HR measurements taken by ECG and BitDoctor Technology.*