Can the BHF spark a transformation to greener heart care?

The British Heart Foundation took a bold position last week, hosting the first national summit on greening cardiac services, organised jointly with the Campaign for Greener Healthcare.

Professor Roger Boyle, National Clinical Director for Heart Disease and Stroke, and Dr Fiona Godlee, BMJ Editor, were among the participants at the summit, which set out to:

• explore the opportunities and challenges of carbon reduction for public health and cardiac care
• understand the context of climate change and carbon reduction in public health and healthcare with particular reference to heart health
• explore the role of the BHF and others in supporting innovation and adoption of low carbon models of care

Dr Godlee set out the global challenge of climate change, and the role of the health profession – particularly in measuring impacts and communicating the health “co-benefits” of reducing greenhouse gas emissions. The BMJ has been leading by example through its coverage of climate change issues over the last 2 years, its support for the Climate and Health Council and the 10:10 campaign. (Is it time for them to go print-free...?)

The BHF Health Promotion Research Group in Oxford is already immersed in the complexities of climate, carbon and health, and Professor Mike Rayner gave a fascinating insight into the relationship between health and sustainability in our diets. The group has been studying the impact of recommendations for a healthy diet on environmental sustainability, economic stability, public health and social inequalities. Although they found some win-wins (such as reducing meat and dairy consumption – which would reduce both greenhouse gas emissions and heart disease), there were also some trade-offs (such as reducing imported fruit and vegetables, or consumption of oily fish). So, no simple answers… But as Professor Rayner concluded, “We can no longer provide health advice which bears no relation to impact on environment.”

After a short presentation from me about the successes of the Green Nephrology Programme, the meeting focussed on the opportunities within cardiac services, to reduce resource consumption while improving quality of care. Discussion centred on increasing health promotion, moving services closer to home, reducing pointless follow-up and supporting patients in caring for themselves. The meeting heard from Dr. Tim Ballard of the Royal College of General Practitioners, on how primary care can help to deliver greener heart care through cardiologists and GPs working together in the community. Amanda Schofield presented a successful pilot from the North West Cardiac Network where remote reporting of ECGs taken in GP surgeries has reduced travel and unnecessary referrals.

It was generally felt that there is much greater scope for using remote wireless technology in diagnosing heart rhythm disorders and in monitoring implanted pacemakers etc. The group was also keen to support more use of telephone and email consultations, as well as patient self-monitoring, to reduce their dependence on the health service.

Dr Mike Knapton, Associate Medical Director of British Heart Foundation summed up the day. Opportunities and challenges of carbon reduction had been explored for cardiac services, public health and health research. We had found that overall the messages are complex and there is need for honesty and clarity in communicating these.

Priority areas identified:

• Technology in health systems
• Social & professional
• Carbon analysis
• Public health: environmental impact of food, travel, alcohol etc

Quoting from David MacKay in his book, Sustainable Energy without the Hot Air, he called for us to “move from adjectives to numbers” – and start measuring the carbon footprint of cardiac services.

The British Heart Foundation has pledged to continue to facilitate dialogue on carbon reduction in heart care.

Participants at the Greener Cardiology Summit - held at BHF offices on 1 March 2010

Click here for Roger Boyle on "leaner greener cardiology" - podcast interview with Muir Gray.