Mapping the intersection of heart rate variability and complementary medicine: a two-decade bibliometric study (2005–2024)

Abstract

Introduction

Heart Rate Variability (HRV), a noninvasive marker of autonomic nervous system function, has become an increasingly utilized tool in complementary medicine (CM) research for objectively assessing physiological responses to interventions. While specific applications of HRV within individual CM modalities have been reviewed, comprehensive mapping of the broader research landscape remains limited. This bibliometric study aimed to provide a detailed overview of the evolution, key contributors, and thematic development of HRV research across diverse CM interventions between 2005 and 2024.

Methods

Original research articles published between January 1, 2005, and December 31, 2024, were retrieved from the Science Citation Index Expanded of the Web of Science Core Collection. A Boolean search strategy combined HRV-related terms with keywords representing a wide range of CM interventions, while deliberately excluding broad or ambiguous descriptors. The data were analyzed using the Bibliometrix package.

Results

A total of 1007 articles published across 375 journals and authored by 4969 individuals were identified, with publication output showing a steady increase and peaking in 2022. China (23.5%) and the United States (19.1%) emerged as the most prolific contributors, although United States publications exhibited a higher average citation rate. Leading institutions included Kyung Hee University (South Korea) and China Medical University (Taiwan). Evidence-Based Complementary and Alternative Medicine was the most frequent publishing journal. HRV and CM research has increasingly appeared in higher-ranked journals over time (p < 0.001). Keyword co-occurrence analysis positioned HRV as a central term, connecting clusters related to mind-body practices, psychophysiological constructs, music therapy, and electroacupuncture. Thematic evolution analysis revealed recent trends toward greater methodological rigor, increased emphasis on patient-centered outcomes, diversification of CM interventions, and incorporation of emerging digital health technologies.

Conclusion

This bibliometric analysis shows HRV research in CM as an evolving field positioned at the intersection of traditional practices, contemporary physiological science, and technological innovation. Recent trends indicate a shift toward increased methodological rigor, greater emphasis on patient-centered outcomes, and integration of digital technologies. As the field advances, novel technologies such as generative artificial intelligence offer promise for deepening physiological insights and enhancing the clinical relevance of CM applications within mainstream healthcare.