Global disparities and future directions in cardio-oncology training: an international survey of cardiology trainees from the international cardio-oncology society

Cardio-oncology has emerged as a vital subspecialty as the population of cancer patients with cardiovascular comorbidities and treatment-related cardiotoxicities grows. Despite its clinical importance, concerns have been raised as to the integration of cardio-oncology into cardiology training. To understand the global landscape of cardio-oncology training, the International Cardio-Oncology Society (IC-OS) carried out a survey of cardio-oncology education. An electronic survey of international cardiology trainees was conducted between March and July 2024. The survey assessed the extent of cardio-oncology teaching, clinical exposure, awareness of cardio-oncology guidelines and professional societies, and interest in future fellowship, research and career in cardio-oncology. 131 cardiology trainees from across the globe responded to the survey, (51% early years trainees, 49% late years trainees). 65% of respondents had cardio-oncology services at their current place of work. Only 39% of respondents reported receiving specific training in cardio-oncology, with significantly global disparity (UK, USA and Canada trainees = 64%, rest of the world 37%, p < 0.001). Clinical exposure was limited, with only 20% of trainees reporting having carried out inpatient cardio-oncology consultations and 17% reporting no cardio-oncology experience. Awareness of the cardio-oncology guidelines was good (75%), with awareness associated confidence in practicing cardio-oncology, as were receiving cardio-oncology training and > 50 h of clinical cardio-oncology experience. This study highlights the urgent need for global standardization of cardio-oncology training, expanded fellowship programs, and increased awareness of guidelines and societies. Addressing these gaps is essential to ensure equitable, high-quality cardiovascular care for cancer patients worldwide.