Cardio-oncology infrastructure, training, and practice patterns in latin america: a multinational survey of 74 institutions

Background Cardiovascular disease remains the leading cause of long-term morbidity and mortality among cancer survivors.1 Recent international position statements have emphasized the need to strengthen cardio-oncology infrastructure, training and multidisciplinary care in Latin America and the Caribbean (LAC).2 However, data on the current structural capacity, competency and practice patterns of cardio-oncology programmes in the region remain limited. Purpose To evaluate cardio-oncology competency, infrastructure, and practice patterns among specialists in LAC. Methods A 44-item cross-sectional survey was distributed by email to cardiologists involved in cardio-oncology across LAC. Responses were collected between December 2025 and February 2026. Duplicate entries were excluded. Descriptive analyses and group comparisons by weekly patient volume were performed using Chi-square and Kruskal–Wallis tests. A multivariable linear regression model was constructed using one response per institution. Results A total of 103 responses were received. After removing duplicates and maintaining 1 response per institute (74). Most participants were cardiologists (96%), with a median of 20 years in practice and 4 years in cardio-oncology practice. Although 64% completed postgraduate cardio-oncology training, 54% reported no formal training during residency. Weekly cardio-oncology volume was 1-5 patients in 47%, 6-25 in 41% and > 25 in 10%. Breast cancer was the most commonly referred malignancy (80%), anthracyclines (88%) and trastuzumab were the most frequently encountered therapies. Hypertension was the most prevalent cardiovascular risk factor (76%). Most specialists reported availability of 2D echocardiography (88%), troponins (82%), BNP/NT-proBNP (80%) and strain imaging (72%). Higher patient volume was associated with practice in second- and third-level institutions, more years in cardio-oncology experience (p < 0.001), and greater availability of strain imaging (p=0.002), cardiac magnetic resonance (p = 0.007), nuclear medicine (p = 0.01), cardiac MRI (p = 0.038) and hematopoietic stem cell transplant programmes (p < 0.003). In multivariable linear regression, compared with low-volume programmes (1 – 5 / week), mid-volume (6 – 25 / week) and high-volume (> 25 / week) programmes had higher resource availability (+2.2 and +2.8 resources out of 12, respectively), independent of formal cardio-oncology unit presence and years of cardio-oncology experience. Education, referral patterns and management strategies were consistent across institutions regardless of patient volume, consistent with ESC 2022 guidelines.3 Conclusion Cardio-oncology care in LAC is concentrated in higher-level institutions, where greater patient volume is independently associated with increased structural and diagnostic capacity. However, formal training during residency remains limited, highlighting an important educational gap in the region.Figure 1.Regional and sociodemographic dataFigure 2.Resource availability analysis