Pulse Pressure-Heart Rate Index and Risk of Adverse Outcomes in Heart Failure

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Pulse Pressure-Heart Rate Index (PPHRi), from pulse pressure and heart rate (HR), reflects vascular stiffness and autonomic tone. It may predict adverse outcomes in heart failure, but evidence across diverse cohorts is limited. We evaluated the association between PPHRi and risk of hospitalization for heart failure or all-cause mortality in the Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment (GUIDE-IT) trial. METHODS We analyzed data from GUIDE-IT, a multicenter randomized trial (2013-2016, 45 U.S./Canadian sites) enrolling patients with heart failure with reduced ejection fraction (HFrEF) to compare NTproBNP-guided therapy with usual care, median follow-up 15 months. The cohort included 2,195 participants with baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR. PPHRi was calculated as (SBP-DBP)/HR and modeled continuously and by median split (≥0.564 vs < 0.564). Cox models adjusted for age and sex assessed associations with first hospitalization or death. RESULTS Mean age was 62 years, 68.7% male. Mean PPHRi was 0.613 (SD±0.258), median 0.564 (range 0.056-2.35). Half were high PPHRi (≥0.564). Higher PPHRi was associated with lower risk of the composite endpoint (continuous: hazard ratio 0.68, 95% CI 0.56-0.81; high vs low: hazard ratio 0.79, 95% CI 0.72-0.86). CONCLUSION Higher PPHRi was independently associated with reduced risk of hospitalization or death, supporting its role as a simple, reproducible prognostic marker.

Volume

87

Issue

13 Suppl

First Page

A574

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A574

DOI

10.1016/j.jacc.2026.02.1532

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