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Enhanced External Counterpulsation (EECP)

FACT SHEET

Definition of EECP

EECP stands for Enhanced External Counterpulsation, a noninvasive, low risk procedure that can reduce or eliminate the symptoms caused by coronary artery blockage.  EECP recruits and enlarges accessory blood vessels known as collaterals, creating new pathways around blocked arteries in the heart, thereby increasing blood flow to the heart muscle.   EECP, as a non-invasive alternative to our standard surgical interventions, balloon angioplasty (PTCA) and bypass surgery (CABG), carries little or no risk, improves one's ability to participate in normal daily activities, and often decreases the need for anginal medication.

   Enhanced - refers to the equipment that has evolved over decades of research and development to become the state-of-the-art treatment delivery system now used in EECP treatment centers.

   External - means treatment happens outside of your body and doesn't require heart catheters, surgery, or lasers.

   CounterPulsation - Sequential inflation and deflation of lower extremity pneumatic cuffs lowers your systolic blood pressure, reducing the workload of the heart, and then counters by raising your diastolic blood pressure, forcing oxygenated blood into your cardiac arteries in a pulsatile fashion..

 Suitable Candidates for EECP

Individuals with chest pain or shortness of breath due to coronary artery disease are likely to benefit from external counterpulsation.  EECP is particularly well suited for patients whose blockages are not technically suitable for angioplasty or bypass surgery, or in whom these  procedures could be carried out only at high risk.   EECP serves as an excellent alternative to further surgery in patients with occluded bypass grafts or coronary artery renarrowing following an initial angioplasty.  EECP is a wonderful breakthrough but it is not a crisis management tool. As an outpatient procedure it has no role in the treatment of the unstable patients. Patients need to be medically stabilized and at least two weeks out from a heart attack, stroke, or angiogram before we can safely begin EECP.

Description of the EECP Procedure

During treatment, you recline on a padded table that contains electronically controlled inflation and deflation valves.  These valves are connected to adjustable pneumatic cuffs that are wrapped firmly but comfortably around your calves, thighs, and lower abdomen.  The cuffs are rapidly and sequentially inflated when the heart enters its resting phase (diastole), and then deflated just before the heart's next contraction (systole).  Heart rate and a non- invasive blood pressure wave form are monitored continuously and used to computer synchronize the timing of cuff inflation-deflation.

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Duration of Treatment

35 one hour treatment sessions comprise a full course of EECP.  Most patients receive a one hour treatment, Monday through Friday, over seven weeks.  Out of town patients can receive two treatments a day, separated by a 4 hour rest interval, shortening their time commitment to 3 1/2 weeks.  Occasional patients receive maximal benefit by extending their course to 45-50 total hours..  

Benefits to the patient

Angina frequency and severity typically decrease, while effort tolerance improves.   Over the first three years of our program, 181 patients completed a course of EECP at our center.  98% improved in terms of functional class, 94% of those experiencing angina noted an improvement and 56% became pain free.  48% were able to discontinue or cut back on their prescription heart medicines.  After receiving EECP, many patients become able to enjoy moderate exercise for the first time since they developed angina.  (Please see Patient Results section for our complete statistics)

Risks to the patient

EECP is non-invasive and does not cause trauma to the patient.  Drugs, lasers, invasive monitoring, and surgery are not involved.  Complications are unlikely in medically stabilized and appropriately selected patients.

Cost Comparison  (Otherwise known as benefits to the insurance company )

EECP costs less than our standard invasive procedures.  The charge for EECP is approximately one third that of angioplasty and one sixth the cost of coronary artery bypass surgery.  EECP, a non-invasive therapeutic technique, costs about the same as coronary angiography, an invasive diagnostic technique.  Additional savings are realized in that a pre-treatment coronary angiogram is typically not required.  The decrease in medication requirement also saves some money. 

Insurance & Medicare Coverage

Nationally, over 120 insurers are covering EECP.  EECP has been covered locally by Medical Mutual, Anthem, most Blue Cross/Blue Shield plans, Aetna, Family Health Plan, 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, and Fountainhead.  Pre-authorization is required for FHP, Paramount, Senior Sense, Paramount Elite, and HMO Health Ohio patients.  Medicare and Medicaid cover EECP in patients with class 3 or class 4 angina who are not good candidates for bypass surgery or angioplasty.  Cigna will not cover EECP at this time; to my knowledge, all the other major insurers are covering EECP.