Pulse Pressure-Heart Rate Index Predicts Adverse Outcomes in Ambulatory Heart Failure: Insights From HF-Action

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), reflecting vascular load and autonomic tone, has been associated with adverse outcomes in advanced heart failure (HF). While pulse pressure and heart rate are individually prognostic, their combined index remains understudied in stable ambulatory patients with reduced ejection fraction. We therefore conducted a secondary analysis of the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial to assess whether baseline PPHRi predicts death or hospitalization. METHODS We analyzed data from 2,055 ambulatory patients in the HF-ACTION trial (2003-2008), which enrolled adults with chronic HF across North America and Europe. PPHRi was defined as (Systolic BP - Diastolic BP)/Heart Rate, modeled continuously and dichotomized at the median. The primary outcome was all-cause death or rehospitalization. Cox models adjusted for age and sex were used. RESULTS The mean age was 59 years (range: 19-90), and 27% were female. Median PPHRi was 0.593 (IQR: 0.295); 49.5% had high PPHRi. Higher (vs. lower) PPHRi was associated with reduced risk of death or hospitalization (HR: 0.84; 95% CI: 0.77-0.92). CONCLUSION Among ambulatory patients with HF, lower PPHRi was independently associated with higher risk of adverse outcomes. PPHRi may serve as a simple, non-invasive tool for risk stratification in chronic HF.

Volume

87

Issue

13 Suppl

First Page

A592

Comments

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

Last Page

A592

DOI

10.1016/j.jacc.2026.02.1573

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