Incremental Prognostic Value of Maximal Inspiratory Pressure Beyond Established Physical Function Assessments in Older Patients With Heart Failure — A Retrospective Cohort Study —

Background: In older patients with heart failure (HF), the Short Physical Performance Battery (SPPB), gait speed, and handgrip strength are recognized prognostic markers. However, whether adding maximal inspiratory pressure (PImax) to these assessments provides incremental prognostic value remains unclear. Methods and Results: This single-center, retrospective cohort study included 258 older patients with HF (mean age, 81.1±7.0 years; 56.2% men) discharged between April 2021 and March 2025. SPPB, comfortable gait speed, handgrip strength, PImax, and maximal expiratory pressure were measured at discharge. Multivariable Cox regression was adjusted for the MAGGIC risk score and log-transformed B-type natriuretic peptide. Within 2 years, 42 patients (16.3%) died. PImax (hazard ratio [HR] 0.65; 95% confidence interval [CI], 0.53–0.80; P<0.001), SPPB (HR 0.88; 95% CI, 0.82–0.95; P<0.001), and comfortable gait speed (HR 0.85; 95% CI, 0.77–0.95; P=0.003) were independently associated with all-cause death. Only PImax remained independent when entered with SPPB (HR 0.70; 95% CI, 0.56–0.87; P<0.001). Although adding PImax to the SPPB-based model did not significantly improve the C-index (0.020; 95% CI, −0.017 to 0.056; P=0.294), it significantly improved reclassification (integrated discrimination improvement 0.061; 95% CI, 0.015–0.132; P=0.008; net reclassification improvement 0.478; 95% CI, 0.124–0.920; P=0.004). Conclusions: PImax was independently associated with 2-year all-cause death in older patients with HF, and its addition to established physical function assessments may improve risk reclassification.