Real-world cardiovascular burden and outcomes in patients referred to a dedicated cardio-oncology clinic

Background

Dedicated cardio-oncology services play a key role in cardiovascular risk stratification and mitigation of cancer therapy–related cardiovascular toxicity (CTR-CVT). However, contemporary real-world data on patients referred to these clinics remain limited.

Methods

Single-center retrospective analysis of consecutive patients evaluated at a cardio-oncology clinic. Baseline cardiovascular risk factors, pre-existing cardiovascular disease, oncologic characteristics and treatments, cardiac investigations, and cardiovascular events during follow-up were assessed.

Results

A total of 133 patients were included (median age 69 years, range 34–88; 37.6% women). Solid tumors accounted for 82.0% of cases—mainly gastrointestinal (31.6%), breast (24.0%) and lung cancer (14.3%)—while 18.0% had hematologic malignancies. Metastatic disease was present in 42.1% and 32.3% were receiving palliative treatment. Prior chemotherapy exposure occurred in one-third of patients and 2.3% had previous CTR-CVT.

Cardiovascular risk factors were highly prevalent: hypertension (67.7%), dyslipidemia (65.4%), diabetes (37.6%) and obesity (24.8%); 79% were classified as high or very high cardiovascular risk. Established cardiovascular disease was common, including coronary artery disease (24.1%), heart failure (30.1%) and atrial fibrillation (23.4%). Over half were receiving beta-blockers or ACE inhibitors/angiotensin receptor blockers.

Baseline echocardiography (available in 75.9%) showed left ventricular dysfunction in 24.1% and regional wall motion abnormalities in 29.3%. Electrocardiography revealed sinus rhythm in 76.7% and bundle branch block in 17.3%.

Among 130 patients initiating anticancer therapy, treatments included cytotoxic chemotherapy (67.7%), anthracyclines (16.5%), targeted therapies (15.8%), anti-HER2 agents (14.3%), immune checkpoint inhibitors (11.3%) and thoracic radiotherapy (27.8%). CTR-CVT occurred in 32.3%, most frequently cardiac dysfunction (18.5%), arrhythmias (9.2%) and vascular toxicity (9.2%). Anti-HER2 therapies (31.0%) and antimetabolites (19.0%) were most commonly implicated. Cancer therapy interruption due to CTR-CVT was required in 17.7%.

Median follow-up was 24.5 months (range 0–109). All-cause mortality was 51.1% and cardiovascular mortality 3.0%.

Conclusion

Patients referred to a cardio-oncology clinic showed a high burden of cardiovascular risk and established heart disease. CTR-CVT was frequent and clinically relevant, often leading to cancer therapy interruption, highlighting the importance of early cardiovascular assessment and structured surveillance strategies.