The GCCF Project: Remote monitoring reduces cardiology’s carbon footprint

By Lucas Marinacci on

Key Points

  • Cardiac device monitoring is a repetitive, long term activity that can be resource intensive.
  • The Global Cardiovascular Carbon Footprint (GCCF) project sought to evaluate the extent to which remote cardiac device monitoring can reduce greenhouse gas emissions.
  • Compared to in-person visits, remote monitoring resulted in a net reduction of nearly 12600 metric tons of CO2 among 67 sites over 2 years, the equivalent of 2 million gallons of gasoline or nearly 15,000 acres of forest land saved.

The healthcare sector contributes to approximately 4-6% of planetary greenhouse gas (GHG) emissions.  The negative effect of GHG on overall and cardiovascular specific health is well described.  Long term monitoring of cardiac implantable devices (CIED) can be resource intensive, and the effect of remote monitoring on carbon footprint (CF) reduction is not known.


On March 5, 2023, Dr. Lakkireddy of the Kansas City Heart Rhythm Institute presented the Impact of Remote Cardiac Device Monitoring on Green House Emissions: Data from the Global Cardiovascular Carbon Footprint (GCCF) Project, with the manuscript simultaneously published in JACC: Advances.1


This study examined 32,811 patients with CIEDs which were monitored remotely over a 2 year period.  An artificial intelligence system was used to identify the distance between the patients home and their device clinics; the mean distance in miles of all patients from each clinic was then calculated.  Weekly gas prices were obtained from the US Energy Information Administration and fuel efficiency data was obtained from the Bureau of Transportation. Carbon emission data for a typical passenger vehicle was obtained from the Environmental Protection Agency (EPA).  AI was also used to calculate the total number of printed pages prevented by using remote monitoring and digital reports, and the CF of paper printing was estimated using publicly available tools on the EPA webpage.


They found that overall, remote device monitoring resulted in a reduction of 31.7 million car miles driven, 3.45 million dollars spent on gasoline, and 12,518 metric tons of CO2 released related to car travel.  Additionally, remote monitoring saved 14.2 million paper prints, the equivalent of 78 metric tons of CO2 production.  Overall saving from remote monitoring in terms of workforce efficiency and paper costs was 6.7 million dollars per year, which came out to 50,000 dollars of savings per clinic per year.


The net effect of remote monitoring over in person monitoring in the study population over two years was a reduction of 12,596 metric tons of CO2, the equivalent to 2 million galloons of gas or 14,907 acres of forest land saved.


This study was limited by its observational nature, and the multiple assumptions regarding GHG emission and mean distances.  Furthermore, the COVID-19 pandemic and associated drops in gas priced coincided with the study period, and may have affected the results regarding cost effectiveness.


When these study results are extrapolated to a global scale, remote monitoring might save 11.12 million metric tons of CO2, the equivalent of 2.8 billion miles driven by an average gasoline powered passenger vehicle.  Promoting remote monitoring efforts “can result in a significant reduction in carbon footprint,” Dr. Lakkireddy concluded. “Industry wide collaborative groups…are needed to reduce the carbon footprint of healthcare operations.”




  1. Bawa D, Ahmed A, Darden D, et al. Impact of Remote Cardiac Monitoring on Green House Emissions: the Global Cardiovascular Carbon Footprint Project. JACC Adv [Internet] 2023;100286. Available from: