From the Research
The apical heart rate is the most accurate method for measuring heart activity, especially in patients with conditions like atrial fibrillation, heart failure, or after exercise, and should be used when accuracy is crucial, whereas the peripheral pulse rate is sufficient for routine assessments in stable adults. The apical heart rate is measured by listening directly to the heart sounds with a stethoscope placed at the apex of the heart, counting the actual heartbeats for a full minute 1. The peripheral pulse rate is measured by palpating an artery and counting the pulse waves for a specified time. These rates may differ due to pulse deficit, which occurs when some heartbeats are too weak to create a palpable pulse wave in peripheral arteries. This difference is particularly important in conditions like atrial fibrillation, heart failure, or after exercise, where accurate heart rate assessment is crucial for guiding treatment decisions, such as the use of inotropes or vasopressors in acute heart failure 2. Healthcare providers should be aware that a significant difference between these measurements (typically more than 2 beats per minute) may indicate cardiovascular issues requiring further evaluation, and the choice of measurement method should be guided by the individual patient's condition and the need for accurate heart rate assessment 1. In general, the apical rate is more accurate and should be used in patients with known arrhythmias or those who are critically ill, while the peripheral pulse is often sufficient for routine assessments in stable adults 1. The recent study by 3 highlights the importance of accurate heart rate assessment in patients with advanced heart failure, where the use of guideline-directed medical therapy, diuretics, inotropes, and palliative care can significantly impact patient outcomes. Overall, the choice of apical or peripheral pulse measurement should be based on the individual patient's needs and the clinical context, with a focus on ensuring accurate heart rate assessment to guide treatment decisions.