Green cardiovascular care: a call for sustainable transformation of cardiovascular practices

Unofficial AI-generated summary based on the public title and abstract. Not an official translation.

🔬研究者:Provides a framework for mapping carbon hotspots in cardiovascular care and suggests research directions for quantitative sustainability interventions.

🏢実務担当者:Offers practical strategies for reducing waste, energy, and resource use in cardiac departments, including single-use device reduction and circular economy adoption.

🏛政策担当者:Highlights the need for payment reforms and policy incentives to embed sustainability into healthcare delivery and reward prevention.

Environmental sustainability has become an urgent global priority as the impact of climate change and environmental degradation, increasingly threatens human health and planetary well-being. The US healthcare sector contributes to an estimated 8.5% of total US greenhouse gas emissions and 27% of all global healthcare greenhouse gas emissions.1 Given the high burden of cardiovascular disease (CVD) and the nature of diagnostics and therapeutics, cardiovascular practices, in particular, have a substantial environmental impact through high utilization of energy, medical devices, pharmaceuticals, transportation, and generation of large amounts of waste. Sustainability considerations however remain conspicuously absent in modern cardiovascular care delivery and operations. The transition to sustainable practices will however require commitment across disciplines, between stakeholders and collaboration between cardiovascular specialists, policy makers, and other healthcare stakeholders including industry. The current model of healthcare delivery carries a substantial carbon footprint that contributes to healthcare’s climate impact, Figure 1. Common and large sources of emissions include energy for lighting, heating, cooling, and operating medical devices (Scope 1 and 2 emissions), transportation and food consumption of patients and staff (Scope 3 emissions), and procurement and waste from medical supplies, devices, and pharmaceuticals (Scope 3).2 Cardiac catheterization labs, in particular, produce significant amount of single-use equipment, including catheters, gloves, drapes, gowns, and etc., in addition to high energy utilization. With more than 1 million estimated catheterization procedures in the US annually, the carbon footprint adds up. Cardiovascular operating rooms also have high energy utilization on account of ventilation, lighting, and medical devices, and anaesthetic utilization with high greenhouse warming potential contributes to significant carbon emission.3 Devices like stents, pacemakers, and implantable cardioverter defibrillators also have environmental impacts from metal and plastic raw materials, manufacturing processes, and transportation. With increasing use of single-use disposable devices, the waste generated in cardiac catheterization labs and operating rooms has risen. Cardiac imaging can also have significant impact on the environment given on energy use, radiation, and contrast material. Beyond the care delivery, the wide array of pharmaceuticals used in cardiovascular care has a significant carbon footprint due to raw material extraction, production, packaging, and transportation. Pathways to a sustainable cardiovascular practice. (A) Key sources of emissions across the cardiovascular care continuum, including energy use, transportation, pharmaceuticals, medical devices, food, and waste. (B) Impactful strategies to improve sustainability at each level of the cardiovascular system Transitioning to sustainable models of cardiovascular care requires a major reorientation of interconnectedness between health, environment, and society (Figure 1). A systems thinking perspective facilitates understanding of the complex dynamics and feedback loops that contribute to sustainability and the close interdependence of multiple systems from the micro to macro (planetary) scale. Specific tools like system dynamics modelling, causal loop diagrams, and health impact assessments allow realization of synergies and avoidance of unintended consequences.4 Reorganization of healthcare practices will require an appreciation of the extent to which cardiovascular practices are embedded within larger networks involving payers, suppliers, social services, public health agencies, and communities. Adopting sustainability measures should therefore consider and account for how decisions propagate through the wider system. These decisions can sometimes seem overwhelming and unattainable. However, even simple actions could have impact through actions on multiple systems, the so called ‘double duty’ or ‘triple duty’ actions. For example, reducing single-use device utilization not only decreases waste and pollution but also impacts cost, healthcare expenditure, and changes demand for these goods. Reducing food waste and single-use plastics in cafeterias in hospitals can impact carbon emissions and pollution but also help with cost. Shifting to plant-based diets in hospitals cannot only reduce carbon emissions but improve health. There is a need for immediate action to promote innovative food systems approaches that promote cardiovascular health while being sustainable.5 Preventing cardiovascular admissions through better population health management may help reduce emission-intensive healthcare utilization and cost. Avoiding or using lower carbon lab tests and diagnostics may help improve sustainability without compromising care. Systems approaches also consider how a hospital can play a role in addressing social determinants in the community like education, housing, and community gardens to prevent chronic diseases and downstream resource utilization. An umbrella cross-cutting organizational sustainability committee can align efforts and foster shared responsibility. The circular economy model framework referred to as the four R’s: reduce, reuse, recycle, and recover, which has since evolved to nine R’s (refuse, rethink, reduce, reuse, repair, refurbish, remanufacture, repurpose, recycle, and recover), is critical.6 A shift to a circular economy model is non-trivial and necessitates substantial transformation in design, production, consumption, use, waste, and reuse practices. It will necessitate a fundamental retreat of industries focused on recycling and remanufacturing and economies of scale. At the individual clinician level, sustainable behaviours involve understanding how our everyday workplace decisions tie into the bigger picture. Clinicians should consider the climate and environmental impacts of diagnostic tests, treatments, devices, and medications they order. They can also help patients understand how lifestyle changes prevent CVD progression and reduce healthcare utilization. For example, telemedicine may offer an opportunity to further reduce healthcare emissions.7 Understanding of the environmental footprint of the imaging examinations can help clinicians make environmental-friendly decisions that optimize patient health and environmental health. In the catheterization laboratories, tailored utilization of devices and kits can have significant impact on the carbon footprint. Reducing the use of disposable custom packs in catheterization and using individual components that are actually needed,8 in addition to re-using some of the supplies (e.g. gowns), can have significant reduction in carbon footprint of catheterization procedures.9 Creating lasting impact requires instilling a culture of sustainability. Leadership commitment is crucial—hospital executives and cardiovascular practice directors must incorporate sustainability into the mission, set bold environmental goals, and dedicate resources. Appointing sustainability and Environmental, Social and Governance officers and green teams provides organizational infrastructure to develop and implement initiatives.10 Changing workplace culture begins with increasing awareness. Simple measures like signs prompting employees to take the stairs, shut off lights, and reduce printing foster daily green habits. Virtual modules, lectures, and training programmes for clinicians and staff build motivation and skills for participating in green initiatives. Discussing sustainability in new employee onboarding conveys these values from the start. To motivate engagement, data linking clinical decisions to emissions, waste, and environmental impacts can be powerful. At the health system level, partnering with professional cardiology societies helps disseminate best sustainability practices and builds consensus. Advocacy for local and national policies that incentivize green healthcare delivery is key to removing barriers. Payment reforms which reward prevention and appropriate resource utilization rather than volume align with sustainability. Embedding sustainability requires reinforcement through words, actions, and symbols that environmental responsibility is integral to cardiovascular care excellence. While challenges remain, conceptualizing sustainability as core to the clinical mission—improving both human and environmental health—creates a paradigm shift. With time, the practices and mindsets required to minimize cardiology’s climate impact will become second nature. Importantly, environmental sustainability aligns with rather than compromises, healthcare’s goal of delivering high-value, high-quality care. Clinicians increasingly recognize sustainability as inherent to their mission of health promotion and view climate action as their responsibility.2 Environmental stewardship also appeals to mission-driven younger staff and enhances recruitment. By broadcasting sustainability commitments, health systems can strengthen community trust and distinguish their brand. Healthcare sustainability ultimately requires clinicians to apply evidence-based green practices in their clinical decisions. Clinical education should integrate sustainability principles in medical school curricula and training. By taking a connected whole systems view, cardiovascular specialists can become powerful change agents in catalysing large-scale transformation. Reconceptualizing cardiovascular prevention as an emissions mitigation strategy recasts its impact as a pillar of sustainable cardiology practice. Prevention offers a prime example of how optimizing both human health and environmental sustainability can be mutually reinforcing. Reducing incidence and severity of CVD decreases procedural interventions, hospital admissions, pharmaceutical use, clinic visits, and medical devices and collectiv

• openalex https://doi.org/10.1093/eurheartj/ehad844first seen 2026-08-02 19:07:08