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Small changes can make a difference: the impact of different ajmaline challenge protocols on carbon footprint
Session:
Sessão de Posters 09 - Epidemiologia e formação médica
Speaker:
Cátia Oliveira
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Cátia Oliveira; Mariana Tinoco; Lucy Calvo; Luís Santos; Ana Pinho; Helena Moreira; Pedro Palma; Miguel Rocha; Gonçalo Pestana; Marta Madeira; Luís Adão; Ana Lebreiro
Abstract
<p style="text-align:justify">Background: Climate change is an urgent public health crisis that significantly impacts disease development and health outcomes. The 2022 Lancet Countdown Report showed an increase in healthcare's emissions to 2.7 Gt CO2 equivalents (CO2eq), which accounts for 5.2% of global emissions. One of the strategies to reduce waste is dematerialization of procedures and simplification of protocols.<br /> Brugada syndrome is an inherited disease associated with sudden cardiac death in structurally normal hearts with characteristic electrocardiographic findings, that might be unmasked by an ajmaline challenge. There are two validated protocols – continuous infusion and intermittent ajmaline bolus administration.<br /> <br /> Purpose: Our aim was to compare the environmental impact of two ajmaline challenge protocols.<br /> <br /> Methods: We performed a retrospective and observational analysis of adult patients (pts) who underwent ajmaline testing between March 2020 and June 2023 in two hospitals. In Group A (infusion protocol), 1mg/kg of ajmaline diluted in 50 mL of 5% glucose solution was infused in 10 minutes, up to the target dose, until a positive result or termination criteria ensued. In Group B (bolus protocol), 10 mg of ajmaline were administered every 2 minutes, again up to the target dose of 1mg/kg (maximum of 100 mg) or test interruption was indicated. Green-house gas emissions (GHGE), resulting from the processing of the materials used in both protocols, were estimated based on previously reported life cycle GHGE of each product’s composition list as described by manufacturers; their weight was measured directly.<br /> <br /> Results: A total of 101 pts were included, 49 pts in group A with a mean age of 47.3±14.3 years and 52 patients in group B with a mean age of 43.9±16.6 years. No complications were observed in either group. Test performance was not evaluated, since both protocols have been previously validated. <br /> Concerning material consumption and waste production, group A produced 5.19 kg of plastic (102 g per test), 1.79 kg of glass and a total consumption of 4.70kg of ajmaline. Group B produce 832 g of plastic (16g per test), 1.58 kg of glass and a total ajmaline use of 4.15kg. Regarding GHGE, group A significantly produced more CO2eq than group B (18.19 kg CO2eq vs 6.23 kg CO2eq, p<0,001).<br /> <br /> Conclusions: Our study shows the significant impact of adopting a more dematerialized ajmaline challenge protocol on the environment protection: swapping from infusion to bolus led to a 66% decrease in CO2eq emissions. As the evidence and awareness of healthcare’s environmental footprint grows, it is important that healthcare professionals implement changes in favor of a more sustainable medical practice. Although our population is small, implementing this environmentally friendly strategy worldwide would have expressive results.</p>
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