In a conversation at HRS with an electrophysiologist from Columbia, I was reminded of what this actually means: We discussed the reuse of single-use electrophysiology devices, and she told me that she wasn’t able to treat all the patients who needed treatment due to the high cost of the devices and the regulatory demand that they be thrown away after a single use. In the United States, we may forget this, but this is the true challenge of expensive healthcare technology: Where resources are constrained, the high costs mean that patients die or need to live with debilitating pharmaceutical care. It doesn’t matter that she can treat one patient well if the consequence is that the patient population suffers.

The issue of physician resource stewardship surfaced most clearly during the pandemic, where PPE shortages, backorders, and other supply issues highlighted the fragility of a healthcare system that was used to consumption without limitations. Physicians are in a uniquely powerful role to address this overconsumption as resource stewards: “[P]roponents of a physician-in-the-lead approach for resource stewardship argue that physicians are qualified to guide resource steward efforts because they have a better understanding of health-related decisions and their consequences compared to nonclinical actors.” In a cardiology guidance document from the pandemic, the authors note that “electrophysiologists play an important role in cardiovascular health, with more than 40% of cardiology encounters being arrhythmia-related” — and homed in on, among other things, resource stewardship.”


From discussions at HRS 2024, I believe that electrophysiologists are increasingly aware that they need to play a role in reducing the cost of electrophysiology procedures in order to deliver the patient care impact they want. At the same time, they are becoming increasingly sensitive to the impact the relentless adoption of new single-use device technology has on the environment. I believe they are truly adopting the sense of resource stewardship that is badly needed in electrophysiology today.

Asking the important questions
Electrophysiologists have always attended HRS to learn about new technologies from the medical technology manufacturers. And this year, again, we saw manufacturers launching new technologies (like PFA) that are more advanced than last year’s technologies. This used to be enough.

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