Putting the Squeeze on Heart Disease
Enhanced external counterpulsation (EECP) is an outpatient treatment for individuals with refractory angina or heart failure who continue to experience severe activity restrictions despite optimal medical therapy. The non-invasive procedure does not replace medication, balloon angioplasty, or bypass surgery, but it is an additional treatment when no further options remain.
What is It?
Patients receive EECP therapy during 35 one-hour sessions.
Photo courtesy of Vasomedical Inc.
EECP therapy uses a computer-controlled device to inflate and deflate three sets of compression cuffs that are wrapped around the patient’s legs and buttocks. Treatment is delivered during one-hour sessions, five days a week, for seven weeks.[1]
How it Works
The compression of blood vessels in the legs increases the venous blood return to the heart. EECP therapy is also thought to improve coronary blood flow and cardiac output and to promote growth of new blood vessels around existing blockages.[2,3]
Who Might Benefit
An estimated 330,000 Canadians have heart failure, while 627,000 have angina.[4] Based on US estimates, about 10,000 Canadians who have angina have chronic refractory disease.[1]
Regulatory Status
The Lumenair™ EECP® Therapy System (Vasomedical Inc., Westbury, NY) was licensed by Health Canada in December 2004 and is indicated for stable or unstable angina, acute myocardial infarction, heart failure, and cardiogenic shock.
The Evidence
Angina
One single-blind randomized controlled trial (RCT) of 139 patients with angina compared EECP with “sham” treatment, where an operator went through the motions of treatment without actually performing it. Patients treated with EECP had significantly increased time to exercise-induced chest pain; however, exercise duration, nitroglycerin usage, and angina counts did not differ between groups.[5]
Heart failure
Preliminary unpublished results from an unblinded RCT of 187 patients with heart failure indicate that those managed with EECP plus medication had improvements in exercise duration, quality of life, and disease severity after six months compared with patients treated with medication alone. There was no difference in peak oxygen uptake[6] and there were no reported differences in adverse events.[3,6]
Several case series and observational studies have also reported benefits of EECP therapy in angina and heart failure; however, the quality of the evidence is poor. [1,3] Long-term treatment outcomes are unknown.[3]
Cost
While provincial governments do not fund EECP therapy, it is available through a small number of private clinics in Ontario. The cost for a one-hour session is approximately C$200, or C$7,000 for a seven-week (35-hour) course of therapy. According to Vasomedical Inc., the purchase price of the Lumenair EECP Therapy System is approximately US$175,000 and includes training for three people and technical support during the first year.
References
[1] Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care. Enhanced external counterpulsation (EECP): health technology policy assessment. Toronto: The Ministry; 2006. Available: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_eecp_030106.pdf
[2] Shea ML, et al. Clin Cardiol 2005;28(3):115-8.
[3] External counterpulsation for treatment of chronic stable angina pectoris and chronic heart failure. [TEC assessment vol 20, no 12]. Chicago: Blue Cross Blue Shield Association; 2005. Available: http://www.bcbs.com/tec/Vol20/20_12.pdf
[4] Chow CM, et al. Can J Cardiol 2005;21(14):1265-71.