PURPOSE: Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. METHODS: Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. RESULTS: Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). CONCLUSIONS: RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. TRIAL REGISTRATION: NL9049 (Dutch Trial Register), registered on 16 November 2020. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-025-05745-5.

Department of Anaesthesiology Intensive Care Medicine and Pain Therapy EvangKliniken Essen Mitte Huyssens Stiftung Knappschaft Essen Germany

Department of Anesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hellerup Denmark

Department of Anesthesia and Intensive Care Military Medical Academy Belgrade Belgrade Serbia

Department of Anesthesiology Aga Khan University Hospital Nairobi Kenya

Department of Anesthesiology and Critical Care and Burn Unit Saint Louis and Lariboisière Hospitals APHP Nord Paris France

Department of Anesthesiology and Intensive Care Institute of Medical Sciences University of Opole Opole Poland

Department of Anesthesiology and Intensive Care IRCCS Humanitas Research Hospital Milan Italy

Department of Anesthesiology and Intensive Care Kepler University Clinic Kepler University Linz Austria

Department of Anesthesiology and Intensive Care Medicine University Hospital Faculty of Medicine Plzen Charles University Plzen Czech Republic

Department of Anesthesiology and Intensive Care University Clinical Hospital Center Zagreb Zagreb Croatia

Department of Anesthesiology and Post Surgical Critical Care University Hospital Doctor Peset Valencia Spain

Department of Anesthesiology and Reanimation Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center University of Health Sciences Istanbul Turkey

Department of Anesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India

Department of Anesthesiology University Medical Center Groningen Groningen the Netherlands

Department of Cardiothoracic Surgery European Interbalkan Medical Center Thessaloniki Greece

Department of Child General and Specialistic Surgery University of Campania Luigi Vanvitelli Naples Italy

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Science and Education Karolinska Institutet SödersjukhusetStockholm Sweden

Department of Critical Care Asgar Ali Hospital Dhaka Bangladesh

Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India

Department of Epidemiology and Data Science Amsterdam University Medical Centre Amsterdam Public Health University of Amsterdam Amsterdam the Netherlands

Department of Intensive Care Adults Erasmus MC University Medical Centers Rotterdam the Netherlands

Department of Intensive Care Amsterdam University Medical Centers Amsterdam the Netherlands

Department of Intensive Care Centro Hospitalar de Entro O Douro E Vouga Santa Maria da Feira Portugal

Department of Intensive Care CHU Charleroi Marie Curie Université Libre de Brussels Charleroi Belgium

Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Copenhagen Denmark

Department of Intensive Care Inselspital Bern University Hospital and University of Bern Bern Switzerland

Department of Intensive Care Pontificia Universidad Católica de Chile Santiago Chile

Division of Pulmonary Critical Care and Sleep Medicine Section of Transfusion Medicine and Therapeutic Pathology University of New Mexico School of Medicine Albuquerque USA

Faculty of Medicine University of Tripoli Tripoli Libya

FHU PROMICE DMU Parabola APHP Nord Paris France

Intensive Care Service Hospital Universitario La Paz Madrid Spain

Intensive Care Unit 1st Department of Respiratory Medicine National and Kapodistrian University of Athens Sotiria Chest Hospital Athens Greece

Médecine Intensive Réanimation CHU de Brest Université de Bretagne Occidentale Brest France

Medical Faculty Ljubljana University of Ljubljana General Teaching Hospital Celje Ljubljana Slovenia

Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK

School of Public Health and Preventive Medicine Monash University Melbourne Australia

School of Public Health and Preventive Medicine The Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Australia

Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador

Université de Lorraine CHRU de Nancy Service de Médecine Intensive et Réanimation Brabois INSERM U116 DCAC Nancy France

Université de Lorraine INSERM Centre d'Investigations Cliniques Plurithématique 1433 Inserm U1116 CHRU de Nancy F CRIN INI CRCT Nancy France

Université Paris Cité INSERM UMR S 942 Paris France

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Raasveld SJ, de Bruin S, Reuland MC, van den Oord C, Schenk J, Aubron C, et al. Red blood cell transfusion in the intensive care unit. JAMA. 2023;330(19):1852–61. PubMed DOI PMC

Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT study: anemia and blood transfusion in the critically ill–current clinical practice in the United States. Crit Care Med. 2004;32(1):39–52. PubMed DOI

Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288(12):1499–507. PubMed DOI

Hayden SJ, Albert TJ, Watkins TR, Swenson ER. Anemia in critical illness: insights into etiology, consequences, and management. Am J Respir Crit Care Med. 2012;185(10):1049–57. PubMed DOI PMC

Hebert PC, Wells G, Marshall J, Martin C, Tweeddale M, Pagliarello G, et al. Transfusion requirements in critical care. A pilot study. Canadian Critical Care Trials Group. JAMA. 1995;273(18):1439–44. PubMed DOI

Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11–21. PubMed DOI

Rygard SL, Holst LB, Wetterslev J, Winkel P, Johansson PI, Wernerman J, et al. Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold: the TRISS randomised, multicentre clinical trial. Intensive Care Med. 2016;42(11):1685–94. PubMed DOI

Vlaar AP, Oczkowski S, de Bruin S, Wijnberge M, Antonelli M, Aubron C, et al. Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 2020;46(4):673–96. PubMed DOI PMC

Carson JL, Brooks MM, Hebert PC, Goodman SG, Bertolet M, Glynn SA, et al. Restrictive or liberal transfusion strategy in myocardial infarction and anemia. N Engl J Med. 2023;389(26):2446–56. PubMed DOI PMC

Coz Yataco AO, Soghier I, Hebert PC, Belley-Cote E, Disselkamp M, Flynn D, et al. Red blood cell transfusion in critically ill adults: an American College of Chest Physicians clinical practice guideline. Chest. 2025;167(2):477–89. PubMed DOI PMC

HEARTS technical package for cardiovascular disease management in primary health care: risk based CVD management

Ding YY, Kader B, Christiansen CL, Berlowitz DR. Hemoglobin level and hospital mortality among ICU patients with cardiac disease who received transfusions. J Am Coll Cardiol. 2015;66(22):2510–8. PubMed DOI

Harrell FE. Regression modeling strategies. Cham: Springer; 2015.

Blet A, McNeil JB, Josse J, Cholley B, Cinotti R, Cotter G, et al. Association between in-ICU red blood cells transfusion and 1-year mortality in ICU survivors. Crit Care. 2022;26(1):307. PubMed DOI PMC

Ducrocq G, Cachanado M, Simon T, Puymirat E, Lemesle G, Lattuca B, et al. Restrictive vs liberal blood transfusions for patients with acute myocardial infarction and anemia by heart failure status: an RCT subgroup analysis. Can J Cardiol. 2024;40(9):1705–14. PubMed

Goldsweig AM, Kostis WJ, Herbert BM, Bouleti C, Potter BJ, Strom JB, et al. Blood transfusion in patients with acute myocardial infarction, anemia, and heart failure: lessons from MINT. Circ Heart Fail. 2025;18(4):e012495. PubMed DOI PMC

Kalra PR, Cleland JGF, Petrie MC, Thomson EA, Kalra PA, Squire IB, et al. Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial. Lancet. 2022;400(10369):2199–209. PubMed DOI

Mentz RJ, Garg J, Rockhold FW, Butler J, De Pasquale CG, Ezekowitz JA, et al. Ferric carboxymaltose in heart failure with iron deficiency. N Engl J Med. 2023;389(11):975–86. PubMed DOI

Corwin HL, Gettinger A, Fabian TC, May A, Pearl RG, Heard S, et al. Efficacy and safety of epoetin alfa in critically ill patients. N Engl J Med. 2007;357(10):965–76. PubMed DOI

Litton E, Latham P, Inman J, Luo J, Allan P. Safety and efficacy of erythropoiesis-stimulating agents in critically ill patients admitted to the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2019;45(9):1190–9. PubMed DOI

Lasocki S, Pene F, Ait-Oufella H, Aubron C, Ausset S, Buffet P, et al. Management and prevention of anemia (acute bleeding excluded) in adult critical care patients. Anaesth Crit Care Pain Med. 2020;39(5):655–64. PubMed

Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R, et al. Treatment of anemia with darbepoetin alfa in systolic heart failure. N Engl J Med. 2013;368(13):1210–9. PubMed DOI

Bosch NA, Law AC, Bor J, Myers LC, Roubinian NH, Liu VX, et al. Red blood cell transfusion at a hemoglobin threshold of 7 g/dl in critically ill patients: a regression discontinuity study. Ann Am Thorac Soc. 2022;19(7):1177–84. PubMed DOI PMC