Cardiovascular disease (CVD) has emerged as a major cause of long-term morbidity and mortality in cancer survivors, often competing with cancer recurrence as a leading risk. A systematic review published in Cardio-Oncology appraised clinical practice guidelines addressing CVD management in adult cancer survivors. A comprehensive search of PubMed, the Cochrane Library, and professional society websites was conducted on January 16, 2025.
Eligible documents included English-language guidelines published between 2000 and 2024 by oncology societies focusing on cardiovascular care in survivorship. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, and recommendations were standardized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Screening and data extraction were performed independently by two reviewers.
Among 524 screened records, 12 guidelines from 7 professional societies met the inclusion criteria. Of these, 2 were rated as high quality and 10 as moderate quality. Risk stratification was consistently identified as the foundation of follow-up care, incorporating baseline cardiovascular risk, cumulative exposure to cardiotoxic therapies, and treatment-related cardiac dysfunction.
The 2022 European Society of Cardiology (ESC) guideline provided a detailed tiered classification, whereas other guidelines, including those from the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN), used simplified approaches. Variability was observed in recommendations for imaging intervals, biomarker use, and thresholds for initiating cardioprotective therapy. Lifestyle interventions and multidisciplinary care were commonly recommended, although implementation strategies and supporting evidence varied.
CVD risk stratification underpins survivorship care across guidelines, but variation in recommendations reflects differences in clinical approaches and available evidence.
