Heart failure with preserved ejection fraction in cancer patients and survivors. A scientific statement of the Heart Failure Association of the ESC and the ESC Council of Cardio-Oncology
Keramida K. Lopez-Fernandez T. Anker M.S. Petrie M.C. Ameri P. Anderson L.J. Bergler-Klein J. Deswal A. Farmakis D. Ibañez B. Lam C.S.P. Lang N.N. Lyon A.R. Mirabel M. Moura B. Paulus W.J. Rakisheva A. Savarese G. Senni M. Tocchetti C.G. Metra M. Filippatos G.
November 2025John Wiley and Sons Ltd
European Journal of Heart Failure
2025#27Issue 112152 - 2167 pp.
Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in cancer patients and survivors, yet it remains underdiagnosed and its epidemiology largely unknown. This statement underscores the imperative need to include HFpEF in the cardiotoxicities identified during or after anticancer treatments. It also highlights the prognostic value of pre-existing HFpEF for periprocedural and cardiotoxicity risk and it discusses the challenges in the diagnosis and treatment of HFpEF in cancer patients. It also explores the aetiologic role of anticancer therapies (chemotherapy, targeted and hormonal therapies and radiotherapy) in the pathogenesis of HFpEF. Special emphasis is given on the importance of considering HFpEF from cancer diagnosis throughout treatment and survivorship and provides useful insights for cardiologists and oncologists in the monitoring and management of these patients. Finally, it highlights the key gaps in current knowledge that require further investigation through well-designed research trials to enhance our understanding and improve clinical outcomes.
Cancer , Cardiotoxicity , Chemotherapy , Heart failure with preserved ejection fraction , Radiotherapy
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Cardiology Department, General Anti-Cancer, Oncological Hospital, Agios Savvas, Athens, Greece
Cardio-Oncology Unit, Cardiology Department, IdiPAZ Research Institute, La Paz University Hospital, Madrid, Spain
Cardiology Department, Quironsalud Madrid University Hospital, Madrid, Spain
Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
Berlin Institute of Health, Berlin, Germany
DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
Department of Internal Medicine, University of Genova, Genoa, Italy
IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. Georges, University of London, London, United Kingdom
Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
National Heart Centre Singapore, Singapore, Singapore
Duke-National University of Singapore Medical School, Singapore, Singapore
Cardio-Oncology Service, Royal Brompton Hospital, London, United Kingdom
INSERM, Paris, France
Institut Mutualiste Montsouris, Paris, France
Armed Forces Hospital, Porto Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam, Amsterdam University Medical Center, Netherlands
City Cardiology Center, Almaty, Kazakhstan
Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
University of Milano-Bicocca, Milan, Italy
Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
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
Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
Cardiology Department
Cardio-Oncology Unit
Cardiology Department
Department of Cardiology
Berlin Institute of Health
DZHK (German Centre for Cardiovascular Research)
School of Cardiovascular and Metabolic Health
School of Cardiovascular and Metabolic Health
Department of Internal Medicine
IRCCS Ospedale Policlinico San Martino
Cardiovascular Clinical Academic Group
Department of Cardiology
Division of Internal Medicine
Department of Cardiology
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)
Cardiology Department
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
National Heart Centre Singapore
Duke-National University of Singapore Medical School
Cardio-Oncology Service
INSERM
Institut Mutualiste Montsouris
Armed Forces Hospital
Department of Physiology and Amsterdam Cardiovascular Sciences
City Cardiology Center
Department of Clinical Science and Education at Södersjukhuset
University of Milano-Bicocca
Cardiovascular Department
Department of Translational Medical Sciences (DISMET)
Cardiology
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