title: Frequency and risk factors of anthracycline-induced clinical heart failure in children: a systematic review.
abstract: BACKGROUND
  Anthracyclines are essential for the treatment of the children with cancer. We performed a systematic review to evaluate the existing evidence of the frequency and risk factors of anthracycline-induced clinical heart failure (A-CHF) in children.
  
  
  METHODS
  Medline was searched for articles reporting the frequency of A-CHF, published from 1966 to December 2000. Information about study features, risk factors and frequency were abstracted, and a validity score was given for each study. The potential predictive factors of A-CHF were analysed both within and across the studies.
  
  
  RESULTS
  The frequency of A-CHF in children was estimated in 30 studies described in 25 articles. All studies have serious methodological limitations. The frequency varied between 0% and 16%. In the analysis across the studies the type of anthracyclines and the maximal dose in 1 week explain a considerable part of the variation of the frequency of A-CHF.
  
  
  CONCLUSIONS
  Doxorubicin and a dose above 45 mg/m2 within 1 week seemed to increase the frequency of A-CHF. Well designed and executed studies are needed to accurately estimate the frequency of A-CHF and reliably assess the importance of potential risk factors.
authors.affiliation: Department of Pediatric Oncology, Academic Medical Centre, University of Amsterdam, The Netherlands. L.C.Kremer@amc.uva.nl
authors.forename: L C M
authors.initials: LC
authors.lastname: Kremer
authors.forename: E C
authors.initials: EC
authors.lastname: van Dalen
authors.forename: M
authors.initials: M
authors.lastname: Offringa
authors.forename: P A
authors.initials: PA
authors.lastname: Voûte
mesh_terms: D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D012307:Risk Factors
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin