Daily Heart Rate per Step: A Wearables Metric Associated With Cardiovascular Disease in a Cross‐Sectional Study of the All of Us Research Program

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Background Simple biometrics such as peak heart rate and exercise duration remain core predictors of cardiovascular disease (CVD). Commercial wearable devices track physical and cardiac electrical activity. Detailed, longitudinal data collection from wearables presents a valuable opportunity to identify new factors associated with CVD. Methods and Results This cross‐sectional study analyzed 6947 participants in the Fitbit Bring‐Your‐Own‐Device Project, a subset of the All of Us Research Program. The primary exposure daily heart rate per step (DHRPS) was defined as the average daily heart rate divided by steps per day. Our analysis correlated DHRPS with established CVD factors (type 2 diabetes, hypertension, stroke, heart failure, coronary atherosclerosis, myocardial infarction) as primary outcomes. We also performed a DHRPS‐based phenome‐wide association study on the spectrum of human disease traits for all 1789 disease codes across 17 disease categories. Secondary outcomes included maximum metabolic equivalents achieved on cardiovascular treadmill exercise stress testing. We examined 5.8 million person‐days and 51 billion total steps of individual‐level Fitbit data paired with electronic health record data. Elevated DHRPS was associated with type 2 diabetes (odds ratio [OR], 2.03 [95% CI, 1.70–2.42]), hypertension (OR, 1.63 [95% CI, 1.32–2.02]), heart failure (OR, 1.77 [95% CI, 1.00–3.14]), and coronary atherosclerosis (OR, 1.44 [95% CI, 1.14–1.82]), even after adjusting for daily heart rate (DHR) and step count. DHRPS also had stronger correlations with maximum metabolic equivalents achieved on exercise stress testing compared with steps per day (∆ρ=0.04, P <0.001) and heart rate (∆ρ=0.31, P <0.001). Lastly, DHRPS‐based phenome‐wide association study demonstrated stronger associations with CVD factors ( P <1×10 −55 ) compared with daily heart rate or step count. Conclusions In the All of Us Research Program Fitbit Bring‐Your‐Own‐Device Project, DHRPS was an easy‐to‐calculate wearables metric and was more strongly associated with cardiovascular fitness and CVD outcomes than DHR and step count.

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