2.50
Hdl Handle:
http://hdl.handle.net/10755/147430
Type:
Presentation
Title:
Accuracy of heart rate assessment in atrial fibrillation (DISS)
Abstract:
Accuracy of heart rate assessment in atrial fibrillation (DISS)
Conference Sponsor:Sigma Theta Tau International
Conference Year:1991
Author:Sneed, Nancee, PhD
P.I. Institution Name:Medical University of South Carolina
Title:Associate Professor
This study was designed to determine the most accurate technique for assessing the heart rate in atrial fibrillation. The literature suggests a number of techniques, but offers no research studies to support which is the most accurate. Based on a conceptual base of physiological principles, it was hypothesized that accuracy differs based on length of counting interval, 15, 30, and 60-seconds, method of measurement, apical or radial, and pulse taker status. Accuracy was defined as the amount of absolute error between the rate per minute obtained by subjects and that from simultaneous electrocardiographic (ECG) and plethysmographic (pleth) recordings. The sample was 94 nurse caregivers, 29 Registered Nurses (RN) in staff nurse positions, 23 Licensed Practical Nurses (LPN), 21 Student Nurses (SN), and 21 Registered Nurses with advanced degrees (RN+). Subjects took 6 randomly ordered measurements of one man in chronic atrial fibrillation. His heart rate varied from 57-111 bpm (mean 81 bpm).



Data were analyzed with a three-factor repeated measures analysis of covariance. Variations in the average heart rate of the pulse source was a significant covariate. The higher the rate, the greater the error. The SN group measured the highest rates. After adjusting for rate differences, there was a significant main effect for caregiver group (F sub(3,89)=5.2, p=.002), and a significant group-by-method interaction (F sub(3,90)=4.17, p=.008). RNs and LPNs were more accurate than the RN+ group with radial pulses. SNs and RNs were more accurate with apical pulses. Assuming a 10 percent error rate is of practical importance, over 75 percent of the subjects made clinically significant errors on radial counts, as did 48 percent on apical counts.



The apical method was significantly more accurate regardless of the standard (ECG or pleth) for radial measurements (F sub(1,90)=72.9l, p<.0001; F sub(1,44)=4.68, p=.036). The difference in radial and apical measurements, using the ECG standard for both, was 9.82 bpm. This was considered clinically significant. The difference using the pleth standard for radial counts (2.67 bpm) was not clinically significant. The average absolute error for all counting intervals and both methods ranged from 7.92-20.52 bpm, all clinically significant.



The 60-second counting interval was significantly more accurate regardless of the standard (ECG -F sub(2,180)=5.19, p=.006; pleth - F sub(2,88)=3.95, p=.023). These differences (1.8-2.2 bpm) were not clinically significant.



In conclusion, errors in counting the heart rate in atrial fibrillation were a significant problem in this study. The apical method and 60-second count were most accurate, but even this method resulted in considerable error. Error increased as the rate increased. Textbook recommendations for measuring the pulse were followed by the subjects with the exception of beginning the count with zero. These findings have significance for making clinical decisions and providing safe care to clients in atrial fibrillation.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAccuracy of heart rate assessment in atrial fibrillation (DISS)en_GB
dc.identifier.urihttp://hdl.handle.net/10755/147430-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Accuracy of heart rate assessment in atrial fibrillation (DISS)</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1991</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Sneed, Nancee, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Medical University of South Carolina</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">sneednv@musc.edu</td></tr><tr><td colspan="2" class="item-abstract">This study was designed to determine the most accurate technique for assessing the heart rate in atrial fibrillation. The literature suggests a number of techniques, but offers no research studies to support which is the most accurate. Based on a conceptual base of physiological principles, it was hypothesized that accuracy differs based on length of counting interval, 15, 30, and 60-seconds, method of measurement, apical or radial, and pulse taker status. Accuracy was defined as the amount of absolute error between the rate per minute obtained by subjects and that from simultaneous electrocardiographic (ECG) and plethysmographic (pleth) recordings. The sample was 94 nurse caregivers, 29 Registered Nurses (RN) in staff nurse positions, 23 Licensed Practical Nurses (LPN), 21 Student Nurses (SN), and 21 Registered Nurses with advanced degrees (RN+). Subjects took 6 randomly ordered measurements of one man in chronic atrial fibrillation. His heart rate varied from 57-111 bpm (mean 81 bpm).<br/><br/><br/><br/>Data were analyzed with a three-factor repeated measures analysis of covariance. Variations in the average heart rate of the pulse source was a significant covariate. The higher the rate, the greater the error. The SN group measured the highest rates. After adjusting for rate differences, there was a significant main effect for caregiver group (F sub(3,89)=5.2, p=.002), and a significant group-by-method interaction (F sub(3,90)=4.17, p=.008). RNs and LPNs were more accurate than the RN+ group with radial pulses. SNs and RNs were more accurate with apical pulses. Assuming a 10 percent error rate is of practical importance, over 75 percent of the subjects made clinically significant errors on radial counts, as did 48 percent on apical counts.<br/><br/><br/><br/>The apical method was significantly more accurate regardless of the standard (ECG or pleth) for radial measurements (F sub(1,90)=72.9l, p&lt;.0001; F sub(1,44)=4.68, p=.036). The difference in radial and apical measurements, using the ECG standard for both, was 9.82 bpm. This was considered clinically significant. The difference using the pleth standard for radial counts (2.67 bpm) was not clinically significant. The average absolute error for all counting intervals and both methods ranged from 7.92-20.52 bpm, all clinically significant.<br/><br/><br/><br/>The 60-second counting interval was significantly more accurate regardless of the standard (ECG -F sub(2,180)=5.19, p=.006; pleth - F sub(2,88)=3.95, p=.023). These differences (1.8-2.2 bpm) were not clinically significant.<br/><br/><br/><br/>In conclusion, errors in counting the heart rate in atrial fibrillation were a significant problem in this study. The apical method and 60-second count were most accurate, but even this method resulted in considerable error. Error increased as the rate increased. Textbook recommendations for measuring the pulse were followed by the subjects with the exception of beginning the count with zero. These findings have significance for making clinical decisions and providing safe care to clients in atrial fibrillation.</td></tr></table>en_GB
dc.date.available2011-10-26T09:32:20Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T09:32:20Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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