The carbon footprint, for an elective DCC, comparing warfarin & NOACs
Research type
Research Study
Full title
The carbon footprint of the DC cardioversion clinical care pathway; has this changed as non-vitamin K oral anticoagulants (NOACs) are replacing warfarin for anticoagulation?
IRAS ID
230497
Contact name
Jonathan Mark Thomas Pierce
Contact email
Sponsor organisation
University of Southampton
Clinicaltrials.gov Identifier
28156, ERGO Application
Duration of Study in the UK
0 years, 3 months, 19 days
Research summary
The NHS is one of the largest emitters of CO2 in the public sector, and in 2015 it had a carbon footprint (CF) of 22.8 million tonnes of CO2 equivalent (MtCO2e). To comply with the Climate Change Act (2008), this will need to be reduced to 4-5MtCO2e p.a. In order to meet these standards and start implementing change, it is essential to evaluate the sustainability and environmental impact of care pathways throughout the NHS.
Atrial fibrillation (AF) is a common condition affecting 5-15% of those over 80 years old. Patients with chronic AF are routinely orally anti-coagulated with either warfarin or increasingly the non-vitamin K oral anticoagulants (NOACs), such as apixaban, rivaroxaban or dabigatran. AF commonly progresses to become persistent, for which one treatment option to restore sinus rhythm is synchronised DCC.
Treatment with NOACs requires less monitoring; a shorter duration between treatment and elective DCC; and possibly reduced rate of cancellations, compared with warfarin treatment. The potential resource implications on the care pathway might include fewer laboratory tests (and transport of samples); less journeys for venepuncture; or less totally wasted journeys when the procedure is cancelled should the level of warfarin anti-coagulation be non-therapeutic.
This therefore begs the question whether there is a significant difference in the carbon footprint of an elective DCC, purely based on whether the patient is prescribed warfarin or a NOAC.
The study will be undertaken both retrospectively, using past patient data from University Hospital Southampton (UHS), and prospectively. The prospective limb will involve patients undergoing elective DCC at UHS during the study period (04/09/17-22/12/17). Patient data will be anonymised for statistical analysis, following receipt of written consent. The study will not involve any direct involvement with the patients whose data is to be analysed.REC name
South Central - Oxford C Research Ethics Committee
REC reference
17/SC/0503
Date of REC Opinion
18 Sep 2017
REC opinion
Further Information Favourable Opinion