From the Guidelines
Heart rate and pulse rate are essentially the same measurement, though they are obtained through different methods, with the key difference being the method of measurement rather than the value itself, as stated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The main distinction lies in how these rates are measured: heart rate is directly measured through methods like an electrocardiogram (ECG) that records the heart's electrical activity, while pulse rate is measured indirectly by feeling the pulse at specific points like the wrist or neck, which reflects the number of pressure waves generated by the heart's contractions. In clinical practice, as guided by recent guidelines like the 2024 ESC guidelines 1, it's crucial to record heart rate accurately and exclude arrhythmias, which can sometimes lead to discrepancies between heart rate and pulse rate, known as a "pulse deficit." This discrepancy can be significant in certain cardiac conditions and may necessitate further medical evaluation. Key points to consider include:
- Heart rate measures the heart's contractions per minute.
- Pulse rate measures the pressure waves felt per minute in an artery.
- In healthy individuals, these two rates should be the same.
- Certain cardiac conditions can lead to a difference between heart rate and pulse rate, indicating potential health issues that require attention, as highlighted by the importance of pulse assessment in the management of hypertension 1.
From the Research
Definition and Measurement
- Heart rate (HR) is typically measured using an electrocardiogram (ECG), which records the electrical activity of the heart 2, 3, 4.
- Pulse rate, on the other hand, is usually measured by feeling the pulse at a peripheral point, such as the radial or apical site 2, 3.
Differences between Heart Rate and Pulse Rate
- Studies have shown that there can be a significant difference between heart rate and pulse rate, particularly in certain conditions such as atrial fibrillation or tachycardia 2, 3.
- The correlation coefficient between pulse rate and ECG heart rate has been found to be relatively low, around 0.54, indicating a poor correlation between the two measurements 2.
- Tachycardia has been found to increase the variance between pulse rate and heart rate, making it more difficult to accurately measure heart rate using pulse rate 2.
Factors Affecting Accuracy
- The accuracy of pulse rate measurement can be affected by various factors, including the counting interval, the method of measurement (apical or radial), and the presence of certain medical conditions 3, 5.
- A 60-second counting interval has been found to be more accurate than shorter intervals, and the apical method has been found to be more accurate than the radial method 3.
Clinical Significance
- Accurate measurement of heart rate is important for clinical decision-making, particularly in patients with cardiovascular disease 4, 6.
- Heart rate variability (HRV) has been found to be a useful clinical research and diagnostic tool, but pulse rate variability (PRV) may not always be an accurate estimate of HRV, particularly during physical activity or mental stress 6, 5.