Cardio-oncology service implementation and guideline adherence in Eastern Europe: a national snapshot

Abstract Background Despite comprehensive international cardio-oncology guidelines, significant gaps persist in their real-world application, especially in resource-limited settings. This study assessed the implementation of evidence-based cardiovascular prevention, surveillance, and management strategies among Romanian physicians treating cancer patients. Purpose to characterize how our respondents currently apply cardio-oncology guidelines, aiming to enable an objective comparison with international data. Methods We conducted a national, anonymous, online survey (September–November 2024) targeting cardiologists, oncologists, hematologists, and internists. A 21-item questionnaire explored institutional context, clinical practices, and adherence to international Cardio-Oncology recommendations. Statistical analyses included chi-squared tests and logistic regression to identify determinants of preventive and surveillance behaviors. Results A total of 214 responses were analyzed. Cardiology and cardio-oncology experience were strong predictors of preventive pharmacotherapy (ACEi, beta-blockers, statins) in both low- and high-risk patients (all p<0.01). Cardiologists more frequently used biomarkers and global longitudinal strain (GLS) for subclinical toxicity screening (p=0.005 and p=0.01, respectively), whereas oncologists relied mainly on LVEF. University hospitals showed greater adoption of guideline-based surveillance (OR 4.7 for GLS use, p=0.002). Cardiologists were also more likely to recommend adjustments of cancer therapy or to initiate cardioprotective treatment in cases of early myocardial dysfunction. Long-term follow-up was inconsistently implemented and largely dependent on the institutional cardio-oncology organization. Conclusions This first national survey reveals substantial variability in cardio-oncology practice across Romania. Adherence to guideline recommendations strongly correlated with specialty, institutional resources, and prior cardio-oncology experience. The findings underscore the urgent need for structured national programs, interdisciplinary training, and resource-adapted surveillance models to close the evidence–practice gap in cardio-oncology care.