Results of the multicenter study of enhanced external counterpulsation (MUST-EECP): clinical benefits are sustained at a mean follow-up time of one year

Impact of External Counterpulsation Treatment on Emergency Department Visits and Hospitalizations in Refractory Angina Patients With Left Ventricular Dysfunction

Patients with refractory angina and left ventricular (LV) dysfunction exert an enormous burden on health care resources primarily because of the number of recurrent emergency department (ED) visits and hospitalizations. Enhanced external counterpulsation (EECP) therapy has emerged as a treatment option for patients with angina and LV dysfunction and has been shown to improve clinical outcomes and LV function. Improvements in symptoms and laboratory assessments in these patients, however, do not necessarily correlate with a reduction in ED visits and hospitalizations. This is the first study to assess the impact of EECP therapy on ED visits and hospitalization rates at 6-month follow-up. This prospective cohort study included 450 patients with LV dysfunction (ejection fraction <or=40%) treated with EECP therapy for refractory angina. Clinical outcomes, number of all-cause ED visits, and hospitalizations within the 6 months before EECP therapy were compared with those at 6-month follow-up. Despite the unfavorable risk profile, refractory angina patients with LV dysfunction achieved a substantial reduction in all-cause ED visits and hospitalization rates at 6-month follow-up. EECP therapy appears to offer an effective adjunctive treatment option for this group of patients.

The immediate and long-term outcome of enhanced external counterpulsation in treatment of chronic stable refractory angina

BACKGROUND

Treatment of angina recalcitrant to conventional pharmacological therapy and revascularization remains problematic. Safe, effective and affordable treatments with high patient acceptability are desirable. Enhanced external counterpulsation (EECP) may fulfil these criteria better than many other proposed interventions.

OBJECTIVE

To examine the immediate and long-term effect of EECP in treatment of chronic stable refractory angina.

DESIGN

Prospective observational study of consecutive patients treated with EECP and follow-up for 1 year.

SETTING

Teaching hospital.

MAIN OUTCOME MEASURES

Canadian Cardiovascular Society (CCS) angina grading, weekly angina frequency and glyceryl trinitrate (GTN) use.

RESULTS

Sixty-one patients were treated with EECP and 58 completed a course of treatment. Further analysis is confined to those who completed EECP. About 52% of patients suffered from CCS III and IV angina prior to EECP. Immediately post-EECP, angina improved by at least one CCS class in 86% and by two classes in 59%. At 1-year follow-up, sustained improvement in CCS was observed in 78% of the patients. The median weekly angina frequency and GTN use were significantly reduced immediately after EECP [7 (4-14) vs. 1 (0-4) episodes per week and 7 (2-16) vs. 0 (0-2) times per week respectively, P < 0.0001; data in median (interquartile range)]. The reduction was sustained at 1-year follow-up. In 48 patients, their mean exercise time improved significantly after EECP [301 +/- 130 s vs. 379 +/- 147 s, P < 0.0001]. Major adverse treatment-related events were rare.

CONCLUSION

This study shows that for patients who fail to respond to conventional measures, a high proportion gain symptomatic benefit from EECP.