Higher efficiencies are achieved with geothermal (ground-source or water-source) heat pumps, which transfer heat between your house and the ground or a nearby water source.
Although they cost more to install, geothermal heat pumps have low operating costs because they take advantage of relatively constant ground or water temperatures.
However, the installation depends on the size of your lot, the subsoil and landscape. Ground-source or water-source heat pumps can be used in more extreme climatic conditions than air-source heat pumps, and customer satisfaction with the systems is very high.