Development and validation of a logistic regression-based nomogram for predicting 1-year all-cause death and heart failure rehospitalization in hypertensive patients with chronic heart failure.

OBJECTIVE: Patients with hypertension and chronic heart failure (CHF) face high risks of poor prognostic outcomes. Effective prevention and management strategies remain a priority. However, the predictive value of platelet-to-high-density lipoprotein cholesterol ratio (PHR) for poor clinical outcomes is unclear. This study aimed to develop and internally validate a predictive nomogram incorporating PHR for assessing the risk of composite endpoint of all-cause death and rehospitalization due to HF in hypertensive CHF patients. METHODS: One hundred eighty-three hypertensive CHF patients admitted to Fuwai Central China Cardiovascular Hospital in 2021 were classified into Event-group (n = 83) and non-Event group (n = 100), with a 12-month follow-up for poor clinical outcomes (all-cause death and heart failure rehospitalization). The composite endpoint (all-cause death or HF rehospitalization) occurred in 83 patients, yielding an overall cumulative incidence of 45.36%. Independent predictors were identified by multivariate logistic regression, and a nomogram was developed and validated by bootstrap resampling. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration charts, and decision curve analysis. RESULTS: History of atrial fibrillation (AF), increased left atrial diameter (LAD), higher neutrophil-to-lymphocyte ratio (NLR), and elevated PHR are independent risk factors for poor clinical outcomes (all P < 0.05). The nomogram incorporating these factors showed strong discrimination with an AUC of 0.814 (95% CI: 0.750-0.878; Hosmer-Lemeshow χ 2 = 4.0329, P = 0.2579) in the modeling group and 0.809 (95% CI: 0.746-0.872; Hosmer-Lemeshow χ 2 = 2.5868, P = 0.4598) in the validation group. Decision curve analysis confirmed clinical utility across broad threshold probability ranges (modeling group: 12%-82%, validation group: 10%-84%). CONCLUSIONS: The nomogram incorporating PHR effectively predicts all-cause death and heart failure rehospitalization risk in hypertensive CHF patients, showing robust clinical applicability.