癌症幸存者患心力衰竭（HF）的风险增加。虽然在癌症化疗时通常会寻找心脏毒性，但随着时间的推移，多次“打击”会导致心力衰竭，并且关于生存期间心力衰竭的频率和原因的证据有限。本系统评价旨在调查心脏毒性与心力衰竭之间的关系。我们检索了 EMBASE、MEDLINE 和 CINAHL 数据库，以查找报告成年幸存者（≥50 岁）发生心力衰竭的研究，这些幸存者在接受潜在心脏毒性癌症治疗后≥5 年。使用随机效应模型来检查 HF 的关联。纳入了 13 篇论文，包括 190 259 名参与者（平均年龄 53.5 岁，93% 为女性）。心力衰竭的风险增加（总体 RR 1.47（95% CI（1.17 至 1.86））。与单独癌症相比，心脏毒性治疗提供了类似的风险（RR 为 1.46（95% CI 0.98 至 2.16））。总体心力衰竭发病率为 2.1%，而对照组为 1.7%，绝对风险差异为 0.4%。在乳腺癌人群比例（11 项研究）中，总体 HF RR 为 2.57（95% CI 1.35 至 4.90）。尽管异质性显着（I2=77.2），但这可以通过患者特征的差异来解释；一旦多变量分析考虑了随访时间（OR 0.99，95% CI（0.97至0.99），p=0.047）、年龄（OR 1.14，95% CI（1.04至1.25），p=0.003）和高血压（OR 0.95） ，95% CI（0.92 至 0.98），p<0.001），残留异质性较低（I2=28.7）。成年癌症幸存者中的 HF 增加，与心脏毒性癌症治疗和标准危险因素相关。然而，幸存者和对照组之间微小的绝对风险差异表明，对幸存者进行普遍筛查是不合理的。基于年龄、心脏毒性癌症治疗和标准风险因素的风险模型可能有助于对这一高危人群进行选择性筛查。© 作者（或其雇主）2024。CC BY 允许重复使用。英国医学杂志出版。

Cancer survivors are at increased risk of heart failure (HF). While cardiotoxicity is commonly sought at the time of cancer chemotherapy, HF develops as a result of multiple 'hits' over time, and there is limited evidence regarding the frequency and causes of HF during survivorship.This systematic review sought to investigate the relationship between cardiotoxic cancer therapies and HF during survivorship.We searched the EMBASE, MEDLINE and CINAHL databases for studies reporting HF in adult survivors (≥50 years old), who were ≥5 years postpotential cardiotoxic cancer therapy. A random effects model was used to examine the associations of HF.Thirteen papers were included, comprising 190 259 participants (mean age 53.5 years, 93% women). The risk of HF was increased (overall RR 1.47 (95% CI (1.17 to 1.86)). Cardiotoxic treatment, compared with cancer alone, provided a similar risk (RR of 1.46 (95% CI 0.98 to 2.16)). The overall HF incidence rate was 2.1% compared with 1.7% in the control arm-an absolute risk difference of 0.4%. In the breast cancer population ratio (11 studies), the overall HF RR was 2.57 (95% CI 1.35 to 4.90)). Although heterogeneity was significant (I2=77.2), this was explained by differences in patient characteristics; once multivariable analysis accounted for follow-up duration (OR 0.99, 95% CI (0.97 to 0.99), p=0.047), age (OR 1.14, 95% CI (1.04 to 1.25), p=0.003) and hypertension (OR 0.95, 95% CI (0.92 to 0.98), p<0.001), residual heterogeneity was low (I2=28.7).HF is increased in adult cancer survivors, associated with cardiotoxic cancer therapy and standard risk factors. However, the small absolute risk difference between survivors and controls suggests that universal screening of survivors is unjustifiable. A risk model based on age, cardiotoxic cancer therapy and standard risk factors may facilitate a selective screening process in this at-risk population.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.