Cardio-oncology: A Review of Heart Failure in Patients with Prior Malignancy and Cancer Therapy-related Cardiac Dysfunction

Abstract

The rising population of cancer survivors, coupled with the expanding arsenal of potentially cardiotoxic cancer therapies, has made heart failure a prevalent and growing concern, necessitating a comprehensive understanding of its prevention, detection, and management within the emerging field of cardio-oncology. This review overviews current literature to provide clinicians and researchers with a cohesive overview of heart failure in patients with prior malignancy and cancer therapy-related cardiac dysfunction (CTRCD). It begins by exploring the diverse pathophysiological mechanisms of CTRCD, from oxidative stress to immunemediated injury, and examines the prevalence and incidence of heart failure among various survivor cohorts. The review then details the clinical presentation and diagnostic challenges unique to this population, emphasizing the critical role of advanced imaging and biomarkers. Current management and treatment strategies are discussed, including pharmacological cardioprotection, lifestyle interventions, and the proven benefits of multidisciplinary cardio-oncology programmes. Finally, it summarizes key clinical trials that inform evidence-based practice, highlighting the protective effects of structured rehabilitation and integrated care models on cardiovascular outcomes. Future research must prioritize large-scale, prospective longitudinal studies to clarify the natural history of CTRCD and validate emerging risk stratification tools. The continued integration of artificial intelligence into diagnostic pathways and the embedding of cardio-oncology principles into standard oncologic care will be essential to personalize treatment and improve long-term outcomes for this vulnerable population