What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=21768). Intervention: Low admission pulse pressure (<30 mmHg) vs. Intermediate pulse pressure (30-60 mmHg). Primary outcome: In-hospital all-cause mortality (OR 1.31, 95% CI 1.06-1.60).

What question did this study set out to answer?

This study investigates the link between admission pulse pressure and in-hospital mortality in heart failure patients.

May 4, 2026Open Access

Low admission pulse pressure and increased in-hospital mortality in patients with heart failure

Q: What question did this study set out to answer?

This study investigates the link between admission pulse pressure and in-hospital mortality in heart failure patients.

LZLiying ZhongXinjiang Medical University MWMeng WeiXinjiang Medical University XZXianhui ZhouXinjiang Medical University

Key Result

Low admission pulse pressure (<30 mmHg) independently increased the risk of in-hospital all-cause mortality (OR 1.31) compared to intermediate pulse pressure (30-60 mmHg) in patients with heart failure.

Key Points

This study investigates the link between admission pulse pressure and in-hospital mortality in heart failure patients.
Retrospective analysis of clinical data from 21,768 patients with heart failure admitted from March 2012 to September 2023.
Used random-forest algorithm to rank predictor importance and multivariable logistic regression for association quantification.
Stratified analysis performed by left-ventricular ejection fraction categories.
Low pulse pressure (<30 mmHg) independently predicted all-cause mortality (OR 1.31, 95% CI 1.06–1.60) and cardiac death (OR 1.80, 95% CI 1.38–2.35).
Lower pulse pressure (<50 mmHg) significantly increased the risk of all-cause mortality and cardiac death.
The association between pulse pressure and mortality risk was consistent across different left-ventricular ejection fraction strata.

Study Design

Type

Cohort (n=21,768)

Multicenter

Structured PICO

Does low admission pulse pressure predict in-hospital mortality in patients hospitalized with heart failure?

Population

21,768 patients with heart failure admitted to the First Affiliated Hospital of Xinjiang Medical University between March 2012 and September 2023

Intervention

Admission pulse pressure <30 mmHg

Comparator

Higher admission pulse pressure

Outcome

In-hospital all-cause mortality and cardiac deathhard clinical

Low admission pulse pressure (<30 mmHg) is an independent predictor of in-hospital all-cause and cardiac mortality in patients with heart failure, regardless of LVEF.

Main Result

Effect estimate: OR 1.31 (95% CI 1.06-1.60)

Absolute Event Rate: 8.58% vs 6.82%

Limitations

Retrospective design precludes causal inference and remains vulnerable to unmeasured confounding.
Data were collected from a single tertiary hospital, limiting external validity.
Pharmacologic therapies and systolic blood pressure were not included in covariate adjustment.
Analysis was restricted to the first pulse-pressure value recorded after admission, introducing potential misclassification bias.
LVEF measurements were not synchronized with blood pressure readings used to calculate pulse pressure.

Abstract

BackgroundPulse pressure (PP) can predict out-of-hospital cardiovascular events in heart failure (HF), yet its prognostic value for in-hospital mortality remains incompletely elucidated. This study aims to investigate the independent association between admission PP and the risk of in-hospital mortality, as well as its consistency across different left-ventricular ejection fraction (LVEF) phenotypes.MethodsWe retrospectively analyzed clinical data from patients with heart failure admitted to the First Affiliated Hospital of Xinjiang Medical University between March 2012 and September 2023 via the electronic medical record system. A random-forest algorithm ranked predictor importance; variables among the top 15 and LVEF were carried forward to multivariable logistic regression to quantify the association between PP and (i) all-cause mortality and (ii) cardiac death. Restricted cubic splines modeled dose-response relationships. Analyses were repeated stratified by LVEF categories.ResultsA total of 21,768 patients were included in the analysis, with 1,541 (7.1%) experiencing in-hospital mortality. After adjustment for the 16 covariates, PP <30 mmHg independently predicted both all-cause mortality (OR 1.31, 95% CI 1.06–1.60) and cardiac death (OR 1.80, 95% CI 1.38–2.35). Restricted cubic spline plots demonstrated that when PP was <50 mmHg, a lower PP was associated with a higher risk of in-hospital all-cause mortality and cardiac death. The relationship between PP and in-hospital mortality was consistent across LVEF strata.ConclusionLow admission PP identifies hospitalized HF patients at heightened risk of in-hospital death, irrespective of LVEF. Integration of PP into early risk-stratification algorithms may facilitate rapid triage and intensified monitoring in this vulnerable cohort.

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