BACKGROUND AND PURPOSE: Heart failure is a well-recognised and serious non-malignant late complication among childhood cancer survivors. The primary aim of conducting this systematic review was to identify, critically appraise and synthesise population-based studies reporting on the incidence and/or prevalence of heart failure in 5-year survivors of childhood cancer (age < 18 years). METHODS: We conducted this systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in April 2021 (registration number: CRD42021247622) and published in June 2022. We searched databases Medline, Embase, Scopus, CINAHL, CAB International, AMED, Global Health, Psycinfo, Web of science and Google Scholar from their inception date until March 14, 2023. Screening, data extraction and quality assessment were conducted independently by two reviewers. The Effective Public Healthcare Practice Project tool was used for quality assessment. RESULTS: Following a comprehensive review of the 3,883 records, only four were found to be eligible for inclusion. The overall quality of the studies was evaluated as strong in two studies and moderate in the remaining two studies. A subsequent meta-analysis of three comparable studies yielded a cumulative incidence of 0.99% (95% confidence interval [CI] 0.57-1.42) over an extended period of 5.0-72.5 years (I-squared = 94.4%, p < 0.001). INTERPRETATION: Existing population-based studies reporting on heart failure in 5-year childhood cancer survivors are few and heterogeneous. Future population-based studies comparing heart failure incidence in childhood cancer survivors with the general population would be of significant value.