Higher comorbidity burden, including renal failure (OR 1.90, 95% CI 1.89-1.91) and COPD, independently predicted ICU admission in heart failure patients, which increased case fatality.
Observational (n=7,265,342)
Yes
What patient characteristics and comorbidities predict admission to an intensive care unit in patients hospitalized for heart failure?
In a nationwide German cohort of over 7 million heart failure hospitalizations, higher comorbidity burden—particularly renal failure, anemia, and COPD—strongly predicted ICU admission, which was associated with a nearly 5-fold increase in in-hospital mortality.
Odds Ratio: 1.9 (95% CI 1.89–1.91)
p-value: p=<0.001
Abstract Background Heart failure (HF) is a clinical syndrome afflicting 1-2% of the adult population and associated with high morbidity and increasing mortality. HF risk stratification is primarily based on symptoms, laboratory markers and left ventricular ejection fraction. Risk stratification depend additionally on patients’ comorbidity burden. Thus, we aimed to identify patient-characteristics, which are associated with admission on an intensive care unit (ICU) in HF. Methods The nationwide German inpatient statistics (NIS) of the years 2005-2022 was used for statistical analysis (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2022, and own calculations). Hospitalizations of patients, who were admitted due to HF in German hospitals, were stratified for ICU admission. Additionally, risk factors for ICU admission were analysed. Results Overall, 7,265,342 hospitalizations of patients admitted due to HF were counted in Germany during the observational period 2005-2022; among them, 498,295 (6.9%) had to be treated on ICUs. HF patients admitted to ICU were slightly younger (76.0 68.0-82.0 vs. 80.0 73.0-86.0 years, P0.001), more often of male sex (56.0% vs. 48.1%, P0.001), obese (14.2% vs 10.5%, P0.001), and had more frequently diabetes mellitus (45.2% vs 38.2%, P0.001) than those without ICU treatment. Comorbidity burden was higher in HF patients who had to be admitted to an ICU, mirrored by a higher Charlson comorbidity index (7.0 5.0-8.0 vs 6.0 5.0-8.0, P0.001), driven by the comorbidities of coronary artery disease (48.5% vs. 40.5%, P0.001), chronic obstructive pulmonary disease (23.2% vs. 16.3%, P0.001) and renal failure (61.4% vs. 47.6%, P0.001). The case-fatality rate of HF patients with ICU treatment was substantially higher compared to those not treated on ICU (23.7% vs. 8.1%, P0.001). The necessity of ICU treatment was independently associated with increased case fatality (OR 4.63 4.59-4.67, P0.001). Besides adverse in-hospital events, which were strongly and independently associated with ICU admission in HF, coronary (OR 1.26 95%CI 1.26-1.27, 0.001) and peripheral artery disease (OR 1.23 95%CI 1.22-1.25, P0.001), atrial fibrillation/flutter (OR 1.20 95%CI 1.20-1.21, P0.001), chronic obstructive pulmonary disease (OR 1.44 95%CI 1.43-1.45, P0.001), chronic anemia (OR 1.52 95%CI 1.51-1.53, P0.001) and renal failure (OR 1.90 95%CI 1.89-1.91, P0.001) were independent risk factors for ICU admission. Conclusion In Germany, 6.9% of the hospitalizations of HF patients were afflicted by ICU admission. Our very large real-world study of more than 7 million patient-cases enables us to identify important risk factors for adverse outcome beyond ejection fraction and laboratory marker assessment. In this context our study emphasizes that patients’ comorbidity burden plays a crucial role in risk stratification of HF patients.
Leuschner et al. (2025) conducted an observational in Heart failure (n=7,265,342). Comorbidity burden (e.g., renal failure) vs. Lower comorbidity burden was evaluated on ICU admission (OR 1.90, 95% CI 1.89-1.91, p=<0.001). Higher comorbidity burden, including renal failure (OR 1.90, 95% CI 1.89-1.91) and COPD, independently predicted ICU admission in heart failure patients, which increased case fatality.