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

Abstract

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 χ2 = 4.0329, P = 0.2579) in the modeling group and 0.809 (95% CI: 0.746–0.872; Hosmer–Lemeshow χ2 = 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.