Risk-Guided Screening Spots Early Heart Damage in Cancer Survivors: REDEEM Trial
Australia: A risk-guided screening approach can successfully uncover hidden heart problems in adults who have survived cancer treatments known to damage the heart, baseline results from the ongoing REDEEM trial have revealed.
The investigators found that nearly one in four long-term survivors carried signs of subclinical or stage B heart failure (SBHF) despite having normal pumping function, highlighting the need for structured surveillance in this growing population.
The REDEEM study, led by Dr. Joshua Wong and colleagues from the Baker Heart and Diabetes Institute in Melbourne, Australia, was published in the American Heart Journal. It focuses on adults aged 40 years and older who had completed potentially cardiotoxic cancer therapy at least five years earlier and who also had at least one established heart-failure risk factor. Participants underwent comprehensive echocardiographic screening to detect subtle cardiac changes before symptoms emerged.
The key findings of the study are as follows:
- Out of 1,124 cancer survivors assessed, 604 underwent complete echocardiographic evaluation.
- Subclinical or stage B heart failure (SBHF) was detected in 145 participants, representing about 24 percent of those screened.
- The average three-dimensional left ventricular ejection fraction remained preserved at around 53 percent.
- Global longitudinal strain averaged 15.6 percent, indicating early, subclinical cardiac dysfunction.
- Reduced cardiorespiratory fitness (VO₂peak ≤18 ml/kg/min) was observed in 39 percent of participants tested.
- Abnormal global longitudinal strain was associated with higher body mass index, diabetes, older age, and prior anthracycline exposure.
- Lower exercise capacity was linked only to increasing age.
- Abnormal strain and diminished fitness did not consistently overlap, suggesting distinct underlying mechanisms.
Eligible participants with SBHF are now being randomly assigned either to a multidisciplinary cardio-oncology disease-management program or to usual care. The intervention includes guideline-based neurohormonal therapy, supervised exercise training, and aggressive risk-factor control. Investigators will measure changes in peak oxygen uptake over six months as the primary outcome to see whether early treatment can prevent progression to overt heart failure.
Dr. Wong and the research team emphasize that there are currently no clear clinical guidelines for heart-failure surveillance in cancer survivors. Their baseline findings demonstrate that a structured, risk-based screening pathway is both practical and revealing, identifying a substantial subset of seemingly healthy individuals who already harbor silent cardiac injury years after chemotherapy.
These results set the stage for the interventional phase of REDEEM, which the authors describe as the first randomized controlled trial designed to test whether proactive, risk-guided disease management can delay or prevent symptomatic heart failure in this vulnerable group.
Reference:
Wong, J., Smith, J., Soh, C. H., Howden, E., Talbot, J. S., Nolan, M., Whitmore, K., Wright, L., Sherriff, A., Sivaraj, E., Wheeler, G., Wiltshire, K., Campbell, P., Ramkumar, S., Tam, C., & Marwick, T. H. (2025). Risk-Guided Disease Management To Prevent Heart Failure In Adult Cancer Survivors of Previous Cardiotoxic Cancer Treatments: Baseline Results of the REDEEM Trial. American Heart Journal. https://doi.org/10.1016/j.ahj.2025.09.009
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