This document (115 pages excluding references, 50 tables, and 48 figures) is the result of an immense undertaking by the European Society of Cardiology (ESC), European Hematology Association, European Society for Therapeutic Radiology and Oncology, and International Cardio-Oncology Society in producing guidelines covering all aspects of the practice of cardio-oncology—the cardiovascular care of cancer patients. The following are 10 key points to remember surrounding these guidelines:

1. The document provides standard definitions for cancer therapy–related cardiotoxicity, guidance on baseline risk assessment, and protocols for surveillance of cardiotoxicity during and after cancer treatment, delving into specifics surrounding individual classes of cancer therapies.
2. Cardio-oncology providers must have a broad knowledge of cardiology, oncology, and hematology, with interdisciplinary communication a crucial component of the practice.
3. A guiding principle of the practice of cardio-oncology is to minimize unnecessary cancer therapy interruptions, with the decision to do so based on multidisciplinary discussions.
4. Echocardiography and blood-based biomarkers are the main methods used in the assessment and monitoring of cardiotoxicity.
5. A new recommendation supports the practice of continuing trastuzumab in patients with asymptomatic and mild decrease in left ventricular ejection fraction (49-50%) while initiating cardioprotective therapy.
6. A new recommendation supports the practice of de-escalating cardioprotective medications in cancer survivors with cardiac function who are at low risk of future cardiovascular events.
7. The vast majority of recommendations are derived from expert opinion (level C evidence), which the document acknowledges upfront through stating that the field of cardio-oncology has limited trials and high-quality evidence on which to base decision making.
8. Class I and III recommendations are summarized in Section 15 of the guidelines and warrant review.
9. Among the class I (must do) recommendations, only five recommendations carry level A evidence:
   • Use of low molecular weight heparin (LMWH) for prophylaxis of venous thromboembolism (VTE) in patients with multiple myeloma and VTE risk factors.
   • QTc monitoring at baseline, 14 days, and 28 days in patients receiving ribociclib.
   • Treatment of VTE with apixaban, edoxaban, or rivaroxaban in patients with VTE and cancer.
   • Treatment of VTE with LMWH in patients with cancer and a platelet count >50,000.
   • Cardiac magnetic resonance imaging for the evaluation of patients with suspected AL cardiac amyloidosis.
10. There are five class III (do not do) recommendations:
    • Avoid QT-prolonging drugs in patients with cancer and Takotsubo cardiomyopathy.
    • Avoid aspirin in patients with cancer and thrombocytopenia if platelets <10,000.
    • Avoid clopidogrel in cancer patients with platelets <30,000; avoid prasugrel and ticagrelor if platelets <50,000.
    • Aspirin or LMWH are not recommended for primary prevention of stroke or systemic thromboembolism in patients with cancer and atrial fibrillation.
    • Diltiazem and verapamil are not recommended for the treatment of hypertension in patients with cancer due to drug-drug interactions.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardio-Oncology, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Anticoagulation Management and Atrial Fibrillation, Anticoagulation Management and Venothromboembolism, Atrial Fibrillation/Supraventricular Arrhythmias, Novel Agents, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound, Magnetic Resonance Imaging

Keywords: ESC22, ESC Congress, Amyloidosis, Antihypertensive Agents, Aspirin, Atrial Fibrillation, Biomarkers, Blood Platelets, Cancer Survivors, Cardiotoxicity, Echocardiography, Heart Failure, Heparin, Low-Molecular-Weight, Magnetic Resonance Imaging, Multiple Myeloma, Primary Prevention, Risk Assessment, Risk Factors, Stroke, Takotsubo Cardiomyopathy, Thrombocytopenia, Trastuzumab, Venous Thromboembolism, Ventricular Function, Left

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