Improving the Carbon Footprint of Medications for Cardiovascular Disease Prevention Using Fixed Dose Combinations

Presenter: C Kennedy

Healthcare systems contribute 4%–5% of global greenhouse gas emissions, while fixed-dose combination (FDC) medications for cardiovascular disease have been associated with improved adherence, reduced cardiovascular outcomes and greater cost-effectiveness. Despite these benefits, FDCs remain underutilised, and their potential environmental impact has not previously been evaluated.

This study estimated the change in carbon footprint associated with increased use of antihypertensive FDCs among patients over 50 years old with hypertension prescribed two or more antihypertensive medications, using data from the Irish Longitudinal Study on Ageing (TILDA). For a population of one million, the FDC utilisation gap was 201,062 individuals per million. The annual carbon footprint of one antihypertensive medication was 7.97 kgCO2eq. Complete adoption of FDCs was estimated to reduce medication-related emissions by 1.60 ktCO2eq, while reductions associated with fewer hospital admissions were estimated at 16.23 ktCO2eq, giving a total annual reduction of 17.82 ktCO2eq. Further modelling is planned to assess uncertainty and the potential impact across other FDC groups and globally.

Mexiletine in Drug-Refractory Ventricular Arrhythmias: Real-World Effectiveness and Tolerability

Presenter: HM Moreira

Drug-refractory ventricular arrhythmias remain a therapeutic challenge in patients despite optimized medical therapy, catheter ablation, and ICD management, while real-world evidence for adjunctive mexiletine remains limited. This retrospective cohort study evaluated the effectiveness and safety of mexiletine in consecutive adults with structural heart disease and an ICD who experienced recurrent sustained VT/VF or frequent appropriate ICD therapies despite optimized treatment. VA burden was assessed for 6 months before and up to 36 months after mexiletine initiation, with the primary endpoint being change in sustained VT/VF episodes and appropriate ICD therapies.

Among 23 patients (median age 68 years, 91% male), 78% had ischaemic cardiomyopathy, median LVEF was 36%, and 30% had undergone prior VT ablation. Median VA burden decreased from 1.04 (IQR 0.54–2.10) to 0.30 (IQR 0.08–0.75) events per month after mexiletine initiation (p<0.01), with 65% achieving a ≥50% reduction in VA event rate over a median follow-up of 23 months. Mexiletine was discontinued in 5 patients (26%), primarily due to hypotension (n=3) and neurological adverse effects (n=2). Four patients died from cardiovascular causes and two underwent heart transplantation. The findings indicate an association between mexiletine use and reduced arrhythmia burden, although adverse effects were frequent and mortality remained high in this population with advanced underlying disease

ESC Congress 2026, 28 - 31 Aug, Munich, Germany