Remote monitoring of cardiac devices during pandemic cut greenhouse gas emissions
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Key takeaways:
- Modeling data of more than 32,000 patients suggest remote vs. conventional monitoring of cardiac implantable electronic devices saved 31.7 million travel miles and reduced greenhouse gas emissions by 12,518 metric tons over 2 years.
- Greenhouse gas emissions saved from remote monitoring during the study period are equivalent to planting about 210,000 new tree seedlings grown over 10 years.
NEW ORLEANS — Remote monitoring of more than 32,000 patients with cardiac implantable devices during the COVID-19 pandemic reduced greenhouse gas emissions by 12,596 metric tons compared with conventional monitoring, researchers reported.
Globally, the health care sector contributes approximately 4% to 6% of planetary greenhouse gas emissions and the U.S. health care sector contributes 8% to 10% of total national greenhouse gas emissions, the highest among industrialized countries, Dhanunjaya R. Lakkireddy, MD, MBBS, FACC, FHRS, clinical electrophysiologist and medical director for the Kansas City Heart Rhythm Institute at HCA Midwest Health and professor of medicine at the University of Missouri, Columbia, said during a Clinical and Investigative Horizons presentation at the American College of Cardiology Scientific Session. Remote monitoring of cardiac devices requires fewer resources than conventional monitoring; however, the impact of such monitoring on greenhouse emissions is unknown, Lakkireddy said.
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“Of all the cardiovascular disease management activities, monitoring of cardiac implantable electronic devices is a long-term, repetitive process associated with downstream costs on the health care system and the environment, making it an important target to look at,” Lakkireddy said during the presentation.
Adding up miles driven, time spent
In an observational study, Lakkireddy and colleagues deidentified obtained data from a third-party remote monitoring provider (Octagos Health) for 32,811 patients from 67 device clinics across the U.S. from July 2020 to June 2022. Clinics were located in Arizona, California, Florida, Kansas, New Jersey, Oklahoma, Pennsylvania and Texas. Researchers calculated the distance from a patient’s home address to the device clinic and determined the savings in total distance traveled during the 2-year study period, using frequency of follow-up required for the device type. National fuel efficiency data and carbon emission data were obtained from U.S. Bureau of Transportation Statistics and the U.S. Environmental Protection Agency, respectively. The average gas price during study period was obtained from the U.S. Energy Information Administration.
“The idea came from a grassroots group called Healthcare Professionals Against Global Warming,” Lakkireddy said. “The Global Cardiovascular Carbon Footprint Project is an idea looking at several ways and means of understanding how carbon emissions happen and how do we home this in. The primary focus has been electrophysiology for us with an open idea of having several others join this effort.”
The researchers also calculated the cost of device monitoring personnel and hours worked in a day (cumulative monitoring hours), the total of printed paper reports during monitoring for each patient and lost efficiency in the outpatient clinics and associated lost revenues from fewer patients seen. Microsoft emission impact dashboard was used to calculate greenhouse gas emissions of information technology devices, servers and cloud computation. An artificial intelligence system identified the distance between patients’ homes and their respective device clinics and calculated mean distance, as well as the total number of printout pages prevented by using remote monitoring and digital access to device reports instead of a traditional printout.
The findings were simultaneously published in JACC: Advances.
Greenhouse gas emissions reduced
Researchers found that remote monitoring saved 31.7 million travel miles and $3.45 million in gas costs while reducing greenhouse gas from gasoline by 12,518 metric tons.
There was a reduction of 14.2 million paper printouts, saving $3 million and reducing greenhouse gases by 78 tons, Lakkireddy said. Additionally, improvement in workforce efficiency with remote monitoring resulted in savings of $3.7 million. There was a net savings of $10.15 million and a reduction of 12,596 tons of greenhouse gas emissions with remote monitoring, Lakkireddy said.
“This is equivalent to about close to 15,000 acres of forest land or planting close to 210,000 new tree seedlings grown for about 10 years,” Lakkireddy said. “This can give you a perspective, for a mere 32,000 remote devices being followed, these are the type of savings we are looking at.”
Lakkireddy cited several study limitations, including that the study period coincided with the COVID-19 pandemic, and a drop in gas prices during the pandemic may have affected the overall cost analysis. Additionally, the mean distances were based on map locations and may be skewed.
Global implications
Lakkireddy added that, globally, there are approximately 10.5 million cardiac implantable electronic devices in circulation, with more than 1.4 million implanted internationally each year. That accounts for about 4.57 million metric tons of greenhouse gas emissions, which is the equivalent of 5.4 million acres of U.S. forests sequestering carbon dioxide for 1 year or 11.4 billion miles driven by an average gas-powered vehicle, or about the greenhouse gas transportation output of the entire state of Rhode Island, he said.
“A simple intervention targeting a very small group of cardiac implantable electronic device patients can result in dramatic changes in the carbon footprint,” Lakkireddy said. “Global warming is real. Our contribution to it is real. Targeting even little steps in the process will make a huge change in contributions to saving this globe from burning itself out.”
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Perspective
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Martha Gulati, MD, MS, FACC, FAHA, FASPC
These data have public health and policy implications for how hospitals can combat greenhouse gases. The United States is responsible for at least one-quarter of the world’s greenhouse gases emitted, and those may not take into account patient visits. The pandemic forced us to rethink the way we do things, and that included remote device monitoring. Yet, the consequences of that change are, to me, quite profound. I found this study very interesting for the way the authors calculated such a visit, in terms of miles traveled, gas saved, paper reduction and staffing needed. This study demonstrated that nearly 13,000 metric tons of greenhouse gases were reduced through this change.
As people are now rolling back pandemic measures, including here in California, lessons learned like this should make us all think about what we can do well remotely vs. in-person. It is everyone’s responsibility to think about how we can do things differently to help our environment. Remote monitoring of devices, when feasible, is certainly one of them.
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Lakkireddy DJ, et al. Clinical and Investigative Horizons. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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