Cardio-oncology care in German hospitals: a multicentre inpatient survey of practices, perceptions and guideline gaps

BACKGROUND: Cancer therapy-related cardiovascular toxicity (CTR-CVT) is a leading non-cancer cause of morbidity and mortality in oncology patients. Implementation of the 2022 ESC Guidelines on cardio-oncology in German inpatient care remains poorly characterised. METHODS: Cross-sectional online survey of 1,435 German hospital departments (February-October 2025). Cardiologists, internists, gynaecologists and oncologists answered items on risk stratification, diagnostics, biomarkers, communication and care quality. RESULTS: 120 physicians responded (cardiologists 36.7%, oncologists 23.3%, gynaecologists 22.5%, internists 17.5%; 73.3% academic/university hospitals). Pre-chemotherapy risk stratification was reported by 85.4% of oncologists and gynaecologists, yet cardiologists were involved in only 28-35%, with heterogeneous risk parameters across specialties. Pre-chemotherapy N-terminal pro-B-type natriuretic peptide (NT-proBNP) use ranged from 85.3% (cardiology) to 15.8% (gynaecology; p < 0.001); 52.6% of gynaecologists used no biomarker. In high-risk patients (anthracyclines plus pre-existing heart failure), gynaecologists monitored significantly less than oncologists at every time point, with 12-month surveillance at 5.3% versus 54.2% (p = 0.001); acute cardiac events were the predominant trigger (36.8%), reflecting reactive rather than proactive practice. Cardiological co-management was median 100% (IQR 50-100) in gynaecology versus 70% (IQR 30-100) in oncology. Dedicated cardio-oncology boards existed in only 1.3% of institutions despite > 70% endorsement; median perceived deficit to optimal care was 50-63%. Top-requested interventions were digital risk-stratification tools (up to 81.8%) and interdisciplinary continuing education (up to 72.7%). CONCLUSION: This survey shows that, among participating hospitals, inpatient cardio-oncology care had substantial guideline-practice gaps. Structured solutions were broadly endorsed: digital risk-stratification tools, post-treatment surveillance and cardio-oncology boards are concrete implementation targets.