Really appreciate the effort to resolve this tricky conundrum.
I think I’m very much with Joost on this.
I’m reluctant to see such a significant breaking change on a very commonly used archetype without a clear need.
Whilst undoubtedly ontologically correct, the difference between heartbeat and pulse is really not significant or recorded in the vast majority of usages, and generally not predictable ahead of time.
Devices will be swapped or not, patients will develop conditions where the difference does become critical (or not), but we cannot know that ahead of time.
I do understand the need to differentiate clearly in some contexts, per patient or clinical setting but I don’t understand why that extra information could not be applied to the existing archetype, with a new optional element if required, that would allow pulse/heartbeat to be differentiated cleanly in those few cases where it is significant.