Is a heart rate of 44 too low? What large studies found about a slow resting heart rate, and when to call your GP

In this article you will read what a low resting heart rate means, and get an answer to the question: is a heart rate of 44 too low? It covers what is normal, what large studies found about a slow heart rate, why trained people often sit so low and which signs mean you should call your GP. That matters, because the same number can be ordinary for one person and a reason to get it checked for another. The difference usually lies in symptoms and in what else is going on, such as medicines that slow the heart.⁠^2,1 The BioProfile heart and vascular scan gives you an indication of where you stand in this area today. The scan is not a diagnosis. It is insight, to see where you stand today and to help you make better choices in your diet and lifestyle. The scan cannot explain your heart rate or assess your heart rhythm. Only a doctor can do that.

What a normal resting heart rate is

Thuisarts gives the rule of thumb: when you are sitting quietly, your heart normally beats between 60 and 90 times a minute.⁠³ In real people, the spread around that guideline is much wider. In wearable device data from 92,457 adults in the United States, collected over two years, the average daily resting heart rate was 65 beats per minute, but personal averages ranged from 40 to 109.⁠⁴ Most people stayed fairly stable, and about one in five had at least one week in which their resting heart rate varied by 10 beats or more.⁠⁴

Put simply: a resting pulse somewhere in the 40s is below the rule of thumb, but it falls within the range of personal averages in this study, which does not show how often a heart rate of around 44 occurs. Your own baseline is the better measure. The researchers reached the same conclusion: everyone has their own resting heart rate, and it can differ a lot from someone else’s.⁠⁴

A Dutch study points the same way for the electrical recording of the heart, the ECG. The study set out normal ECG values for each age group, using 13,354 people aged 16 to 90 with a healthy heart from four Dutch population studies, and most values differed between women and men.⁠⁵ So a single number for everyone is only a rough guide. You will find the usual values for each age on our page about a normal heart rate.

Is a heart rate of 44 too low? What large studies found

The clearest answer comes from the Multi-Ethnic Study of Atherosclerosis in the United States, which followed 6,733 people aged 45 to 84 who had no cardiovascular disease at the start for 10 years. A heart rate below 50 was not linked to more cardiovascular disease, whether or not people took medicines that affect the heart rate.⁠¹ In people who did not take such medicines, a heart rate below 50 was not linked to a higher risk of death either. In people who did take such medicines, a heart rate below 50 came with a clearly higher risk of death, more than two times as high.⁠¹

What this means: in this group, a slow heart rate with no symptoms and no medicines that slow the heart was not linked to extra risk over ten years. That does not prove a heart rate of 44 is harmless for everyone who feels well. If you take a medicine that slows the heart, talk to your doctor about a very low number.⁠¹

A larger share of the research looks at the other end of the scale. A meta-analysis of 46 studies, covering more than 1.2 million people from the general population, found that every 10 extra beats per minute at rest came with a slightly higher risk of dying, from any cause and from heart and vascular disease. Above 80 beats per minute, the risk was clearly raised.⁠⁶ Put simply: across the whole population, the worrying signal in these figures comes from a high resting pulse more than from a low one.⁠⁶

Why trained people often sit lower

In athletes, a slow heart rhythm between 30 and 60 beats per minute is described as a normal adaptation of the body to regular, intensive training.⁠² It is common. Studies report it in 98 per cent of elite professional cyclists and in half of male footballers.⁠² So if you train hard and often, a resting pulse of 44 can simply be a sign of that training.⁠² You can read what too little exercise does to your body in what too little exercise does to your body.

When a condition is the cause of a slow heart rate

A slow heart rate can also be caused by a problem in the heart rhythm itself. Sick sinus syndrome is one such rhythm disorder, and the researchers describe it as a common reason for a pacemaker.⁠⁷ Two population studies in the United States followed 19,893 people aged 45 and over for an average of 17 years. None of them had a pacemaker or atrial fibrillation at the start, and 213 participants developed sick sinus syndrome, so it is uncommon.⁠⁷ After adjusting for other factors, people who developed the syndrome were nearly three times as likely to develop heart failure, and the syndrome was strongly linked to getting a pacemaker. Their higher risk of death disappeared once cardiovascular disease that developed during the study was also taken into account.⁠⁷

Put simply: sick sinus syndrome is uncommon, and it is serious when it does occur. That is why symptoms count for more than the number alone.⁠²

When to see your GP

In athletes, a heart rate below 30, or a slow heart rate that comes with symptoms, is a reason for further tests.⁠² If you feel your heart beating hard, fast or irregularly, Thuisarts says: call your GP or the out-of-hours GP service straight away if any of these things is also going on: pain or pressure in your chest that does not go away after a few minutes, difficulty breathing, the feeling that you are about to faint, or a heartbeat that suddenly feels different from normal and does not settle after sitting quietly for a while. The same applies if you feel confused, have trouble speaking, see differently or have a drooping face, and if you feel restless, sick, sweaty or look pale.⁠³

If you have fainted, call straight away if you had chest pain or that feeling of palpitations just before, if your arms and legs jerked for a while, if you were unconscious for more than 3 minutes, or if you were confused for 5 minutes or longer after coming round.⁠⁸ Make an appointment with your GP on a working day if you fainted without feeling it coming, if you have fainted more than once, if you are older than 70, if you take medicines that lower your blood pressure, or if family members under 40 have heart problems or have died suddenly of a heart problem.⁠⁸ In most cases, fainting is harmless and is caused by your blood pressure dropping for a moment.⁠⁸ You can read which heart symptoms women may notice in heart symptoms in women.

Put simply: in the large study, a low number without symptoms and without medicines that slow the heart was not linked to extra risk. A low number with chest pain, difficulty breathing, feeling faint or fainting is a reason to call.⁠^1,3

What the heart and vascular scan shows

The heart and blood vessel scan gives you a baseline for this area of your health: a value that shows where you stand today and that you can compare against later. The scan is self-insight. The scan is not a diagnosis. Whether a slow heart rate is harmless in your case is for a doctor to judge, based on your rhythm, your medicines and your symptoms.⁠¹ Noting your resting heart rate on a few quiet mornings tells you more than a single measurement, because everyone has their own baseline.⁠⁴

In summary

A resting heart rate of 44 is below the rule of thumb of 60 to 90 beats per minute,⁠³ but it falls within the range of personal averages in the study with wearable devices and within what counts as an adaptation to training in athletes; these sources do not show how often a heart rate of around 44 occurs.⁠^4,2 One large study found no extra risk from a slow heart rate in people who do not take medicines that slow the heart, and more risk in people who do take such medicines.⁠¹ Sick sinus syndrome, a rhythm disorder behind a slow pulse, is uncommon and serious.⁠⁷ Whether a heart rate of 44 is too low for you depends on your symptoms, your medicines and your own baseline, and the warning signs from Thuisarts tell you when to call.⁠^3,8