OBJECTIVE To evaluate the prognostic value of measuring heart rate variability (HRV) in horses with colic at the time of admission to a referral hospital. ANIMALS 51 horses > 1 year of age with colic (41 that survived [survivors] and 10 that died or were euthanized [nonsurvivors]). PROCEDURES HRV was recorded within 1 hour after admission by use of heart rate sensors with horses restrained in stocks. A 5-minute recording period was analyzed to obtain HRV measurements (eg, SD of R-R intervals [SDRR], root mean square of successive differences between R-R intervals [RMSSD], and geometric SDs determined from Poincaré plots [SD1 and SD2]). Variables associated with outcome (survival vs nonsurvival) were identified. Measurements were compared among diagnostic categories for colic (obstructive, inflammatory, or ischemic). RESULTS SDRR and RMSSD were significantly higher in survivors (median [25th to 75th percentile], 91.0 milliseconds [78.9 to 114.6 milliseconds] and 64.8 milliseconds [40.9 to 78.4 milliseconds], respectively) than in nonsurvivors (50.7 milliseconds [29.1 to 69.2 milliseconds] and 33.4 milliseconds [12.6 to 47.9 milliseconds], respectively). Similarly, SD1 and SD2 were significantly higher in survivors (48.3 milliseconds [28.9 to 60.9 milliseconds] and 111.3 milliseconds [93.0 to 146.6 milliseconds], respectively) than in nonsurvivors (23.7 milliseconds [8.9 to 33.9 milliseconds] and 65.1 milliseconds [33.7 to 91.9 milliseconds], respectively). The SDRR and SD2 were significantly higher for horses with obstructive colic than for horses with ischemic colic. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of HRV in horses with colic may provide information on the underlying cause and be helpful in identifying horses less likely to survive.