Prevention of cancer therapy-related cardiac dysfunction and heart failure in cancer patients and survivors. A Clinical Consensus Statement of the Heart Failure Association, the European Association of Preventive Cardiology of the ESC, and the ESC Council of Cardio-Oncology

Amina Rakisheva¹, Dimitrios Farmakis², Andrea Attanasio³, Antoni Bayes Genis⁴, Alain Cohen-Solal⁵, Geeta Gulati^{6

7}, Martin Halle⁸, Loreena Hill⁹, Teresa Lopez Fernandez^{10

11}, Alexander R Lyon¹², Brenda Moura^{13

14}, Ciro Santoro¹⁵, Carlo Gabriele Tocchetti¹⁶, Sophie van Linthout¹⁷, Vassilios Vassiliou¹⁸, Yusuf Ziya Sener¹⁹, Makhabbat Bekbosynova²⁰, Marco Metra²¹, Giuseppe Rosano^{22

23}, Massimo Piepoli^{3

24}

Affiliations

¹ City Cardiology Center, Almaty, Kazakhstan.
² Heart Failure and Cardio-Oncology Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece.
³ Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.
⁴ Heart Institute, Hospital Universitari Germans Trias i Poujol, Badalona, Spain.
⁵ Universite Paris Cite, INSEM U942, Cardiology Department, Lariboisiere Hospital, AP-HP, Paris, France.
⁶ Division of Medicine, Department of Cardiology, Oslo University Hospital, Oslo, Norway.
⁷ K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁸ Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
⁹ School of Nursing and Paramedic Science, Ulster University, Londonderry, UK.
¹⁰ Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain.
¹¹ Cardiology Department, Hospital Universitario Quironsalud, Madrid, Spain.
¹² Cardio-Oncology Centre of Excellence, Royal Brompton Hospital, London, UK.
¹³ Armed Forces Hospital, Porto, Portugal.
¹⁴ Faculty of Medicine of University of Porto, Porto, Portugal.
¹⁵ Department of Advanced Biomedical Science, Federico II University, Naples, Italy.
¹⁶ Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
¹⁷ BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, Berlin, Germany.
¹⁸ Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.
¹⁹ Department of Cardiology, Thoraxcentrum, Erasmus MC, Rotterdam, The Netherlands.
²⁰ UMC, Astana, Kazakhstan.
²¹ ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
²² Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy.
²³ IRCCS San Raffaele, Rome, Italy.
²⁴ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.

PMID: 40679941
DOI: 10.1002/ejhf.3753

Prevention of cancer therapy-related cardiac dysfunction and heart failure in cancer patients and survivors. A Clinical Consensus Statement of the Heart Failure Association, the European Association of Preventive Cardiology of the ESC, and the ESC Council of Cardio-Oncology

Amina Rakisheva et al. Eur J Heart Fail. 2025.

. 2025 Jul 18.

doi: 10.1002/ejhf.3753. Online ahead of print.

Authors

Affiliations

¹ City Cardiology Center, Almaty, Kazakhstan.
² Heart Failure and Cardio-Oncology Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece.
³ Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.
⁴ Heart Institute, Hospital Universitari Germans Trias i Poujol, Badalona, Spain.
⁵ Universite Paris Cite, INSEM U942, Cardiology Department, Lariboisiere Hospital, AP-HP, Paris, France.
⁶ Division of Medicine, Department of Cardiology, Oslo University Hospital, Oslo, Norway.
⁷ K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁸ Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
⁹ School of Nursing and Paramedic Science, Ulster University, Londonderry, UK.
¹⁰ Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain.
¹¹ Cardiology Department, Hospital Universitario Quironsalud, Madrid, Spain.
¹² Cardio-Oncology Centre of Excellence, Royal Brompton Hospital, London, UK.
¹³ Armed Forces Hospital, Porto, Portugal.
¹⁴ Faculty of Medicine of University of Porto, Porto, Portugal.
¹⁵ Department of Advanced Biomedical Science, Federico II University, Naples, Italy.
¹⁶ Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
¹⁷ BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, Berlin, Germany.
¹⁸ Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.
¹⁹ Department of Cardiology, Thoraxcentrum, Erasmus MC, Rotterdam, The Netherlands.
²⁰ UMC, Astana, Kazakhstan.
²¹ ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
²² Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy.
²³ IRCCS San Raffaele, Rome, Italy.
²⁴ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.

PMID: 40679941
DOI: 10.1002/ejhf.3753

Abstract

Despite advances in cancer treatments with significant improvement in patient outcomes, chemotherapy, targeted molecular therapies and radiotherapy may cause a range of cardiovascular complications, such as cancer therapy-related cardiac dysfunction (CTRCD), which represents a broad spectrum of possible presentation and aetiological link with the broad scope of various cancer therapies, including chemotherapy, targeted agents, immunotherapies, and radiation therapy, aiming at reducing the associated morbidity and mortality. However, practical guidelines on the primary prevention of CTRCD in high-risk patients, a key element in improving prognosis, are lacking in cancer patients and related evidence remains inconclusive. This Clinical Consensus Statement, authored by experts from the Heart Failure Association (HFA) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC), and the ESC Council of Cardio-Oncology, aims to discuss the definition and epidemiology of CTRCD, the implicated factors for risk stratification, and the appropriate early diagnostic pathways, while focusing on lifestyle modifications, and pharmacological interventions to reduce the incidence of CTRCD. In addition, a holistic cardio-oncology management approach is advised for prevention and long-term management.

Keywords: Cancer patients and survivors; Cancer therapy‐related cardiac dysfunction; Heart failure prevention.

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References

1. Lyon AR, López‐Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler‐Klein J, et al. 2022 ESC Guidelines on cardio‐oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio‐Oncology Society (IC‐OS). Eur Heart J 2022;43:4229–4361. https://doi.org/10.1093/eurheartj/ehac244
1. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016;37:2768–2801. https://doi.org/10.1093/eurheartj/ehw211
1. Deng H, Fan R, Zhai Y, Li J, Huang Z, Peng L. Incidence of chemotherapy‐related cardiac dysfunction in cancer patients. Clin Cardiol 2024;47:e24269. https://doi.org/10.1002/clc.24269
1. Darby SC, Ewertz M, McGale P, Bennet AM, Blom‐Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013;368:987–998. https://doi.org/10.1056/NEJMoa1209825
1. Lyon AR, Dent S, Stanway S, Earl H, Brezden‐Masley C, Cohen‐Solal A, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: A position statement and new risk assessment tools from the Cardio‐Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio‐Oncology Society. Eur J Heart Fail 2020;22:1945–1960. https://doi.org/10.1002/ejhf.1920

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Prevention of cancer therapy-related cardiac dysfunction and heart failure in cancer patients and survivors. A Clinical Consensus Statement of the Heart Failure Association, the European Association of Preventive Cardiology of the ESC, and the ESC Council of Cardio-Oncology

Affiliations

Prevention of cancer therapy-related cardiac dysfunction and heart failure in cancer patients and survivors. A Clinical Consensus Statement of the Heart Failure Association, the European Association of Preventive Cardiology of the ESC, and the ESC Council of Cardio-Oncology

Authors

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources