Abstract

Aims Climate change poses a major threat to global health, with implications for cardiovascular disease. Cardiovascular imaging warrants attention due to its environmental footprint. Despite recognition of the need for climate-conscious healthcare, awareness and implementation of sustainable practices among cardiovascular imagers remain unclear. This study aims to assess current awareness, knowledge, and attitudes regarding climate change and sustainable cardiovascular imaging. Methods and results An anonymous 2-month online survey was disseminated via European Association of Cardiovascular Imaging newsletters, social media, and direct invitations. It explored: (i) general environmental consciousness, (ii) knowledge of climate–cardiovascular links, (iii) perceived barriers, strategies, incentives, and communication tools, and (iv) the survey’s potential influence on practice. A total of 218 participants from 41 countries responded (51% female; 91% cardiologists; and 84% Europe). Only 11% had received formal education on climate or sustainable healthcare. Self -reported environmental consciousness was low in 12%, moderate in 65%, and high in 23%. While 90% acknowledged healthcare professionals’ responsibility in addressing climate change, 60% rarely considered environmental impact when requesting imaging. Knowledge was limited: only 63% correctly answered ≥4 of 7 questions. Main barriers were the lack of awareness (47%) and institutional or medico-legal pressures encouraging frequent imaging (33%). Reducing unnecessary imaging and improving education were seen as the most effective strategies to address these barriers (50%). After completing the survey, 84% reported greater inclination to consider sustainable practice. Conclusion This international survey highlights a gap between environmental concern and its integration into cardiovascular imaging. Education, institutional support, and system-level strategies are needed to foster sustainable practice.