Clinical Outcomes

• Significant reduction in Angina Symptoms: EECP therapy has been shown to reduce the frequency, severity, and duration of angina episodes in patients with chronic stable angina. Many patients experience a significant reduction in angina symptoms and an improvement in their overall quality of life. In some studies, up to 85% of the patients undergoing EECP treatment had a reduction by at least 1 CCS class (1) (Canadian Cardiovascular Society (CCS) Angina Grade). In the recent 2023 study by Dr Timothy Henry, published in the American Journal or Cardiology, showed that after EECP treatment, 71 patients (70.3%) had an improvement of ≥1 CCS angina class, including 33 (32.7%) patients improving by ≥2 CCS classes.(2) In another study, they measured clinical outcomes for 2 years after EECP therapy in patients with refractory angina pectoris and left ventricular dysfunction(3) and found:
  
• 77% angina reduced by at least one class
• 52% stopped using nitroglycerin
• 81% had no congestive heart failure exacerbation during the 2 year follow-up period
• Increased Exercise Tolerance: Patients undergoing EECP therapy often demonstrate improved exercise tolerance, as evidenced by increased duration of exercise and reduced exertion symptoms such as chest pain or shortness of breath.

• Enhanced Myocardial Perfusion: EECP therapy has been associated with improvements in myocardial perfusion, which refers to the blood flow to the heart muscle. This may help to reduce ischemia (inadequate blood supply) and improve cardiac function.

• Reduction in Nitrate Use: Some patients who undergo EECP therapy may be able to reduce their reliance on anti-anginal medications and other cardiovascular medications over time. This can lead to cost savings and a decreased risk of medication-related side effects.

• Quality of Life Improvement: EECP therapy has been shown to improve various aspects of quality of life, including physical functioning, emotional well-being, and social interaction. Patients often report feeling more energetic, less limited by their symptoms, and better able to participate in daily activities.

• Mortality Benefit: While the evidence is not conclusive, some studies suggest that EECP therapy may be associated with a reduction in mortality and major adverse cardiac events (such as heart attack or stroke) in certain patient populations, particularly those with severe coronary artery disease.

• Prolongation of time to exercise induced ST segment depression: Studies have shown that patients undergoing EECP treatment exhibit a significant increase in the time to onset of ST-segment depression during stress tests, indicating improved myocardial perfusion and reduced ischemia.

• Reduction in hospitalisation: They investigated the impact of Enhanced External Counterpulsation treatment on emergency room visits and hospitalisations(4) and found that:
  • • Emergency room visits reduction of 86%
    • Hospitalisations reduction of 83% 

• Improvement in LV Function

• Low Major adverse cardiovascular events (MACE) rates at long term follow up

• Long-term Durability: EECP therapy has demonstrated long-term durability of its benefits, with many patients experiencing sustained improvements in symptoms and functional status for 3 to 5 years after completing the treatment course.

References: 

1. Raza, A., Steinberg, K., Tartaglia, J., Frishman, W. H., & Gupta, T. (2017). Enhanced External Counterpulsation Therapy: Past, Present, and Future. Cardiology in review, 25(2), 59–67. https://doi.org/10.1097/CRD.0000000000000122 [Pubmed]
2. Ashokprabhu, N. D., Fox, J., Henry, T. D., Schmidt, C. W., Tierney, D., Gallatin, J., Alvarez, Y. R., Thompson, L., Hamstra, M., Shah, S. A., & Quesada, O. (2024). Enhanced External Counterpulsation for the Treatment of Angina With Nonobstructive Coronary Artery Disease. The American journal of cardiology, 211, 89–93. https://doi.org/10.1016/j.amjcard.2023.10.061 [Pubmed]
3. Soran, O., Kennard, E. D., Kfoury, A. G., Kelsey, S. F., & IEPR Investigators (2006). Two-year clinical outcomes after enhanced external counterpulsation (EECP) therapy in patients with refractory angina pectoris and left ventricular dysfunction (report from The International EECP Patient Registry). The American journal of cardiology, 97(1), 17–20. https://doi.org/10.1016/j.amjcard.2005.07.122 [Pubmed]
4. Soran, O., Kennard, E. D., Bart, B. A., Kelsey, S. F., & IEPR Investigators (2007). Impact of external counterpulsation treatment on emergency department visits and hospitalizations in refractory angina patients with left ventricular dysfunction. Congestive heart failure (Greenwich, Conn.), 13(1), 36–40. https://doi.org/10.1111/j.1527-5299.2007.05989.x [Pubmed]