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

Background Pulse 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. Methods We 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. Results A 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. Conclusion Low 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.