Given the relative importance of cardiovascular disease treatment in healthcare, it makes sense to focus on this question: How can we address and reduce the carbon emissions footprint of cardiovascular care while sustaining or increasing the quality and reach of this care?
An estimated 4.4% of all GHG emissions worldwide are from healthcare.
In an article in Nature Reviews Cardiology from October 25 (Rajagopalan, Sanjay, et al.(2024)): Environmental sustainability in cardiovascular practice: current challenges and future directions, nature reviews cardiology), the authors distinguish between economic, environmental and social sustainability of healthcare practices: Economic incentives to change business as usual is the most likely driver of change in general, but direct economic incentives/punishment for specific behaviors, doesn’t work really well in a healthcare setting where we are primarily concerned about saving lives. In other words, whereas most environmental sustainability models are based on economic inducement, these don’t work in cardiovascular care, because economic outcome is not the most important thing: Savings lives is.
In my mind, this simply means that you will only find a path to improved sustainability of cardiovascular care in the confluence between care quality, economics, and the environment: Solutions that favor only two of the three will not reduce the carbon footprint of cardiovascular care. Environmental solutions that are economically incented don’t work if care quality goes down; environmental solutions that increase care quality at economic cost don’t work; care quality improvement that reduce costs are not going to do anything good for the environment; etc.
This may be why healthcare is lagging behind other sectors in the US economy when it comes to a focus on sustainability: A 2018 survey of 49 health-care organizations in the USA found that only 6 published sustainability reports. In other sectors GHG emissions and other environmental sustainability metrics are routinely accounted for.
Various steps have been taken to induce healthcare facilities to engage in GHG reporting and GHG emission. In 2024, the Joint Commission launched a new GHG voluntary certification program that “requires transparent measurement of the GHG emissions of an organization and to have a reduction plan among other institutional requirements to support the commitments”. This is a great initiative, but, once again, the certification model does not address how negotiate GHG emission reduction goals against the overall goal of not adversely affecting health outcomes: The “fundamental expectation of healthcare delivery places the health of the patient first and foremost.”
In electrophysiology (EP), which is the fastest growing cardiac treatment type, researchers estimate 250,000 pounds of CO2 emissions daily from EP procedures (equivalent to 170 pounds per procedure). Some researchers have pointed out that the reuse of single-use medical devices may by where to start. Regulated single-use device reprocessing and reuse is legal in the US and some European countries, but adoption is fragmented and limited. To get to a point where single-use device reprocessing really makes a difference in healthcare CO2 emissions, all parties have to be involved: Physicians must be willing to change their practice, manufacturers must accept reprocessing and design devices for easy reprocessability, and hospitals need to engage in new practices to prioritize reprocessed products and incorporate new practices in their purchasing system.
In summary, the authors of the Environmental Sustainability in Cardiology Practice suggest that instead of an economic incentive model, GHG emissions reductions can be driven by models where “carbon emissions can be thought of as an additional factor in decision-making for health care (provided that the interventions themselves are equally efficacious and safe).[…] This approach includes choosing a medical or surgical intervention on the basis of carbon emissions (assuming that cost, efficacy and safety are the same)” (my italics).
The challenges are these:
How do you make cardiologists interested?
Cardiologists (Electrophysiologists) need to be fundamentally interested in reducing their carbon emissions impact, or a GHG reduction program will not work. While some Electrophysiologists may be intrinsically interested, all will not be, and economic incentives are needed to drive behavioral change. Reprocessing is unique in that costs are driven down at the same time as environmental benefits are realized; A physician share in the cost reductions could provide the incentive needed.
How do you make EP administrators interested?
As mentioned, single-use device reprocessing is a unique environmental sustainability program in that substantial cost savings are realized while GHG emissions is reduced. Creating a practice for constantly evaluating the relevant results from a reprocessing program can provide the necessary incentive and awareness of a program’s positive outcomes (money, environment, patient care).
How do you measure, report, and impact GHG emissions?
Accurately measuring and tracking the EP lab’s carbon emissions may be an insurmountable task, given the many different devices, drugs, processes, and staff involved. However, what the lab CAN do to create visibility around its GHG emissions reductions, is to obtain GHG reporting from its vendors. Simply making it mandatory to provide LCA (Life-Cycle Analysis) metrics and do regular GHG reporting will give EP Labs a powerful tool in their pursuit of measurable results.
Regular models for incentivizing environmentally sustainable behavior are not relevant in healthcare. However, the contribution of healthcare to GHG emissions is substantial, and it is necessary to identify models and best practices for how to incentivize GHG emission reduction behavior among doctors and administrators. A vendor-based GHG accountability solution provides a pathway – as long as patient care quality and costs stay where they are.