What is EECP?
Ar you wondering what is EECP Therapy? Well wonder not more! EECP Therapy is a non-surgical solution for symptomatic Coronary Artery Disease. In an effort to discuss the benefits of EECP Therapy, we must evaluation CAD and why EECP Therapy is a suitable treatment options for this disease.
Goals for Management of Coronary Artery Disease (CAD) and Angina
Reduce Mortality and Morbidity
Eliminate angina or equivalent symptoms (i.e. SOB, fatigue, and palpitations)
Return the patient to a normal active lifestyle, including the ability to exercise
Eliminate angina or equivalent symptoms (i.e. SOB, fatigue, and palpitations)
Return the patient to a normal active lifestyle, including the ability to exercise
Prevalence of Angina and Heart Failure:
5 million Heart Failure patients in the U.S./ 500,000 new cases a year
9 million Angina patients in the U.S./ 400,000 new cases a year 3
13.6 million angina attacks per week despite medication
25.6% of patients have angina 1 year post angioplasty or stent4
10.5% of patients have angina 1 year post CABG5
9 million Angina patients in the U.S./ 400,000 new cases a year 3
13.6 million angina attacks per week despite medication
25.6% of patients have angina 1 year post angioplasty or stent4
10.5% of patients have angina 1 year post CABG5
Evidence suggests that EECP improves symptoms & decrease long-term morbidity via:
Improvement in endothelial function
Promotion of collateralization
Enhancement of ventricular function
Improvement in oxygen consumption (VO2)
Regression of atherosclerosis
Peripheral training effects similar to exercise2
Promotion of collateralization
Enhancement of ventricular function
Improvement in oxygen consumption (VO2)
Regression of atherosclerosis
Peripheral training effects similar to exercise2
ECP is the only true non-invasive technique for which both:
A reduction of CAD and angina symptoms with improvement in objective measures of myocardial ischemia
Improvement in LV function (both systolic and diastolic) has been shown
Improvement in LV function (both systolic and diastolic) has been shown
Hemodynamic changes from ECP:
Increased venous return
Increased preload/stretch
Increased Cardiac Outputb
Retrograde arterial flow
Increased diastolic pressure with increased intra-coronary perfusion
Increased vascular recoil and systolic unloading
Decreased systemic vascular resistance
Decreased after-load
Decreased myocardial oxygen consumption
Increased preload/stretch
Increased Cardiac Outputb
Retrograde arterial flow
Increased diastolic pressure with increased intra-coronary perfusion
Increased vascular recoil and systolic unloading
Decreased systemic vascular resistance
Decreased after-load
Decreased myocardial oxygen consumption
Recent trends in coverage and reimbursement:
FDA indications expanded to include heart failure, based on established safety and efficacy
Expanded description of anginal equivalent symptoms to include shortness of breath, fatigue and palpitations on exertion
Expanded physician discretion to treat an additional 10-15 sessions to achieve patient improvement by at least one class*
Expanded physician discretion to repeat therapy annually*
Annual increase (past 4 years) in reimbursement per treatment hour
Expanded description of anginal equivalent symptoms to include shortness of breath, fatigue and palpitations on exertion
Expanded physician discretion to treat an additional 10-15 sessions to achieve patient improvement by at least one class*
Expanded physician discretion to repeat therapy annually*
Annual increase (past 4 years) in reimbursement per treatment hour
The ECP Device is FDA approved for treatment of:
Stable and Unstable Angina
Congestive Heart Failure
Acute MI
Cardiogenic Shock
Congestive Heart Failure
Acute MI
Cardiogenic Shock
Medicare Inclusion Criteria:
Patients with documented Coronary Artery Disease or Ischemia by non-invasive or invasive testing such as: angiography, stress, nuclear stress, ECG or Holter
Canadian Classification Class III or IV anginal or anginal equivalent symptoms (chest pain, SOB, fatigue, palpitations) on exertion interfering with activities of daily living despite medical therapy
Patients deemed not readily amenable to surgical intervention
Canadian Classification Class III or IV anginal or anginal equivalent symptoms (chest pain, SOB, fatigue, palpitations) on exertion interfering with activities of daily living despite medical therapy
Patients deemed not readily amenable to surgical intervention
Example of ECP Candidates:
Ischemic Cardiomyopathy including those with EF
0% that are medically compensated
Patients who refuse invasive treatment
The elderly, diabetics
Unsuitable coronary anatomy such as small, diffuse and/or distal vessel disease
Prior failed revascularization
Ischemic valve dysfunction
Stunned or hibernating myocardium with reduced wall motion
Renal insufficiency
Multiple co-morbid medical problems
Moderate to severe angina who cannot tolerate medical therapy
Silent ischemia and early positive stress test
Severe anatomy
Prinzmetal Angina or Micro-vascular angina
Excessive nitrate use
Exercise intolerant
Patients whose quality of life is significantly impaired and become sedentary due to fear of inducing angina symptoms of chest pain, S.O.B., fatigue or palpitations.
0% that are medically compensatedPatients who refuse invasive treatment
The elderly, diabetics
Unsuitable coronary anatomy such as small, diffuse and/or distal vessel disease
Prior failed revascularization
Ischemic valve dysfunction
Stunned or hibernating myocardium with reduced wall motion
Renal insufficiency
Multiple co-morbid medical problems
Moderate to severe angina who cannot tolerate medical therapy
Silent ischemia and early positive stress test
Severe anatomy
Prinzmetal Angina or Micro-vascular angina
Excessive nitrate use
Exercise intolerant
Patients whose quality of life is significantly impaired and become sedentary due to fear of inducing angina symptoms of chest pain, S.O.B., fatigue or palpitations.
Contraindications: Absolute
Abdominal Aortic Aneurysm (surgical size AAA ≥ 5cm)
Active Deep Vein Thrombophlebitis on any limb subject to treatment
Aortic Insufficiency (moderate to severe A.I. may exacerbate regurgitation)
Peripheral Vascular Disease involving occlusion of the ileofemoral arteries
Active Deep Vein Thrombophlebitis on any limb subject to treatment
Aortic Insufficiency (moderate to severe A.I. may exacerbate regurgitation)
Peripheral Vascular Disease involving occlusion of the ileofemoral arteries
Contraindication: Relative and Precautionary subject to proper management
Surgical intervention within 6 weeks prior to ECP
Cardiac catheterization within 1-2 weeks prior to ECP
Uncontrolled arrhythmias if they interfere with device triggering
Atrial pacing if it interferes with device triggering
Anti-coagulation therapy with INR>2.6
Uncontrolled BP (Systolic ≥ 180, Diastolic ≥ 110)
Heart Rates ≤35 or ≥125
Severe pulmonary disease (safety data on severe pulmonary HTN unavailable)
Local infection or Vasculitis of the extremities
Burn, wound or fracture on any limb subject to treatment
Pregnancy
Cardiac catheterization within 1-2 weeks prior to ECP
Uncontrolled arrhythmias if they interfere with device triggering
Atrial pacing if it interferes with device triggering
Anti-coagulation therapy with INR>2.6
Uncontrolled BP (Systolic ≥ 180, Diastolic ≥ 110)
Heart Rates ≤35 or ≥125
Severe pulmonary disease (safety data on severe pulmonary HTN unavailable)
Local infection or Vasculitis of the extremities
Burn, wound or fracture on any limb subject to treatment
Pregnancy
