EECP – Enhanced External Counterpulsation
EECP is an enhanced external counterpulsation. It is a cost-effective, non-invasive, non-surgical, non-pharmaceutical, outpatient therapy for patients with angina, heart attack, and heart failure. It is approved by the FDA (USA) and the NHS (UK).
How is the EECP performed?
During EECP The patient lies on the bed of the machine. Three or five electrodes are applied to the chest to record a constant ECG.
A plethysmograph is applied to the index finger to record a tracing representing blood pressure and oxygen saturation.
The set of 3-4 cuffs wraps around the calves, thighs, and buttocks. The EECP system uses an ECG signal to electronically synchronize cuff inflation and deflation.
What is the duration of the treatment?
The duration for patients with chronic angina and heart failure is 35 hours, generally one hour per day, five days per week. Some patients choose a regimen of 2 hours per day, which reduces the time to completion of treatment. The duration of the treatment and the rest interval will depend on the patient’s condition, how much diastolic increase is obtained, the patient’s tolerance and the indications for the application of EECP.
What is the EECP mechanism?
Clinical studies indicate that EECP treatment can create a ‘natural’ bypass of blocked arteries. There are basically two mechanisms involved in this therapy. When we produce diastolic surge, this results in the opening of many inactive blood vessels in the heart, helping to bypass blocked channels. Also, this treatment encourages the blood vessels to form new small vessels, ie colletrals. These channels or collaterals can eventually become permanent pathways to heart muscle that previously lacked adequate blood flow and oxygen.
What are the indications for EECP?
Patients with angina not relieved by medication, patients who do not want to undergo bypass surgery, patients who are contraindicated for bypass or angioplasty such as renal failure, liver failure, severe COPD, diffuse diabetes disease, very old age , patients with syndrome X, that is, patients with microvessel disease, ischemic and dilated cardiomyopathy can opt for EECP.
What are the contraindications of EECP?
Severe aortic regurgitation and aortic stenosis, deep vein thrombosis, pregnancy, very high blood pressure, and severe peripheral vascular disease are contraindications for EECP.
EECP Side Effects
EECP has no side effects except for minor skin bruises, especially when the patient does not wear proper leather pants during treatment. Unlike angioplasty or bypass, it is a completely safe procedure with no major risks for the patient.
Patient Benefits
After EECP, the patient can walk longer distances without feeling chest pain or shortness of breath. The patient’s quality of life improves remarkably. You can participate in daily activities. Above all, the medicine of the patients also decreases, there is less need to take sublingual nitrates. After treatment, heart failure patients do not need to take a large amount of diuretics.
Verification of EECP results.
Before and after treatment, we performed ECG, echocardiography, TMT test, and thallium stress scan. All of these tests verify the EECP results. On ECG there is a marked decrease in ST-segment depression or other ischemic changes, there is an increase in ejection fraction on echo, the TMT test shows that the patient can walk longer distances without chest pain, and the thallium stress test also shows that there is less or no more ischemia in the heart.
What is the cost of EECP?
The charge for EECP is about one-third the cost of angioplasty and one-sixth the cost of coronary artery bypass surgery. In Pakistan, EECP charges are US$2400 at Dr. Armughan EECP Cardiac Clinic Sialkot.
Insurance and Medicare coverage
In the US, more than 120 insurers cover EECP. EECP has been covered locally by Paramount, John Hancock, Senior Sense, Paramount Elite, Workman’s Comp, HMO Health Ohio, Messa, Acordia, Access, Envirosource, EV Benefits, First Health, Harrington Benefits, Fortis, Gallagher Benefits, NGS American, United Health Care, Health Alliance Plan, Medical Mutual, Anthem, most Blue Cross/Blue Shield plans, Aetna, Family Health Plan, and Fountainhead. Prior authorization is required for FHP, Paramount, Senior Sense, Paramount Elite and HMO Health Ohio patients. Medicare and Medicaid cover EECP for patients with class 3 or class 4 angina (chest pain) who are not good candidates for CABG surgery.