corner

EECP Article

Can EECP Treatment, a Non-Invasive Heart By-Pass Therapy, bridge the gap between Cardiac Patients & Heart Specialists?

EECP

Can EECP Treatment, a Non-Invasive Heart By-Pass Therapy, bridge the gap between Cardiac Patients & Heart Specialists?

By:
Dr. Asmita Chaturvedi; M.D.(Internal Medicine)
Dr. Deepak Chaturvedi; M.D. (Internal Medicine)




EECP

With the rise in the number of heart patients in India and limited resources to take care of them, Can EECP Treatment, a Non-Invasive Heart ByPass Therapy bridge the gap between Cardiac Patients & Heart Specialists; to Reduce Mortality and Morbidity and improve Quality of life? This is a question which needs to be evaluated and explained to the population with valid logics and explaination.

In India, with a population of 1.3 Billion and a prevalence of about a 35-40 million people suffering from compromised cardiac (heart) health, there are:

  • Only 1500 cath labs.
  • Only 5000 Super specialist Cardiologists.
  • Only about 1500-2000 Cardiothoracic surgeons in about 160-170 centers operate on about 70,000 to 1 lac patients every year.
  • The addition of even 200 cath labs every year is not enough to deal with the newly added Cardiac Patients (Heart Patients).

EECP

There is enough evidence and data to show the increasing gap between the demand and supply in managing Heart ailments (including Coronary Artery Diseases) because of the following reasons:

  • Interventional Cardiac management like Angioplasty and CABG need skilled Interventional Super specialist cardiologists and Cardiothoracic Surgeons.
  • The statistics mentioned above (number of Cathlabs, Super specialist Cardiologists, CVTS Operation theaters and Superspecialist Cardiothoracic Surgeons ) are not favorable considering the massive load of the disease and fewer service providers.
  • The modern life style and stresses keep on adding in the incidence of Coronary Artery Disease.
  • Chronic nature of Cardiac (Heart ailments) needs lifelong care, and the prevalence keeps rising.

EECP

Do we need newer modalities to take care of heart patients?

In the current scenario, the existing Cardiac health infrastructure is insufficient to handle the chronic cases of Heart ailments. There is a need for Consultant physicians with a specialty in Medicine (M.D.; Medicine) to come ahead and build a support system for the superspecialists (D.M.; Cardiology and M.Ch.; Cardiothoracic Surgery). It is critical to managing these chronic cases of Heart diseases (including Coronary Artery Diseases) effectively in a timely fashion.

In this ecosystem, the superspecialists would be working inside the cath labs and CVTS operation theaters and do Angioplasties, CABG, and other cardiovascular interventions, and the Consultant Physicians take care of these patients later and support them lifelong.

As the demand and supply of the Cardiac infrastructure are imbalanced and the acute cases (new cases) need immediate interventions; the superspecialists will find themselves more involved in Interventional procedures to meet the demand because of the rising incidence of Heart ailments (including coronary artery diseases). The consultant physicians with the vast knowledge of Internal and Systemic Medicine can work towards improving managing the cardiac patients and add non-invasive procedures like EECP to their setup.





What is EECP?

EECP stands for Enhanced External Counterpulsation. The best part is that This is an OPD procedure and does not require hospitalization, although a monitoring period and physician supervision are necessary. It works on the principle of Diastolic Augmentation, which increases coronary blood flow during Diastole and opens the collateral circulation in the Heart.

What is the basic “Principle” behind EECP?

EECP works on the principle of creating a “counter-pulse” towards the Heart using “Pulsatile Pneumatic Compressions”.

EECP

What are the effects of “EECP” on Heart?

  • EECP improves the Cardiac Function by improving the perfusion of the Coronary Vasculature (Blood Supply to the Heart itself).
  • EECP opens up the new collaterals and hence improves the circulation and perfusion.
  • It improves the micro-circulation of the Heart (including Distal perfusion).
  • EECP improves the Ejection capacity of the Heart.

Does EECP treatment improves Circulation to other Vital Organs too?

EECP presumably improves the circulation to other Vital Organs of the body (Brain, Kidney etc.)

How many sessions of EECP are required?

EECP is popularly known as the Natural Coronary Bypass procedure (though it is a misnomer). Usually, 40 sessions are required once daily for 40-50 minutes to achieve optimal results. The outcome may not be identical and depends on a case-to-case basis. Careful pre-EECP clinical evaluation, realistic expectations, and correct selection of the candidate for EECP help avoid patient and clinician dissatisfaction.

EECP

Who can benefit from EECP Therapy?

  • The patients blockages in their heart blood vessels but not significant enough for interventions like Angioplasty and Bypass surgery.
  • The Patients having Refractory Angina (symptoms persisting with maximum medications possible).
  • The patients having symptoms even after getting their procedures done (Angioplasty or CABG).
  • The patients having significant blockages in their heart blood vessels but are unfit for surgery.
  • The patients who are advised to redo Angioplasty or CABG.
  • The patients waiting for their Angioplasty or CABG for any reason.
  • The patients having heart failure and symptoms not improving despite being on multiple medicines.
  • The patients having fear or anxiety about going for any invasive intervention.

Can EECP treatment improve symptoms of Chronic Heart Failure?

Yes, EECP treatment may improve the objective and subjective feeling and symptoms in patients of CHF.

What are the parameters of improvement after EECP treatment?

Improved 6 minutes walk test, Echocardiographic improvement , ECG findings, Subjective Feeling of Wellbeing and Symptomatic improvement.

EECP

What is the FDA Status of “EECP”?

  • FDA Approved for Certain Heart Conditions like Chronic Stable Angina, Refractory Angina and Congestive Heart Failure (symptomatic and stable).
  • EECP is most commonly used as “Adjunctive Treatment” in Heart Patients (mainly IHD; commonly known as “Blockages” and Heart Failure).

Why are patients not receiving EECP Therapy?

It is a matter of great concern that the patients who, for whatever reason, are either not fit or not willing to undergo the invasive intervention despite all the explanations given to them are left alone without offering non-invasive intervention like EECP. It seems that clinicians and patients do not have enough information about EECP treatment, which is the only plausible explanation. However, the truth remains that selected qualified heart patients may benefit from EECP treatment.

FAQ

What does EECP mean?

EECP stands for “Enhanced External Counter Pulsation.

Is “EECP” Known as “Natural Bypass Treatment”?

Yes, it is popularly known as “Natural Bypass Treatment”.

Is “EECP” an “Invasive” treatment?

No, EECP is entirely a non- invasive procedure.

In which Position the “EECP” treatment is given?

You will be lying on a special treatment table wrapped in three sets of cuffs (like large blood pressure cuffs) around the calves, lower and upper thighs and buttocks.

What is the basic “Principle” behind EECP?

EECP works on the principle of creating a “counter-pulse” towards the Heart using “Pulsatile Pneumatic Compressions”.

How are the “Cuffs” inflated and deflated?

The EECP treatment system includes a compressor that uses air to inflate and deflate the cuffs( first the calf then the thigh and last the buttock cuff).

What happens with Inflation of the cuffs during EECP treatment?

The pressure moves the blood from the lower limbs toward the heart. Each pressure wave is timed to patient’s heartbeat so as to reach the heart when it is relaxing and the blood flow to the heart arteries is maximized.

What happens with deflation of the cuffs during EECP treatment?

  • When the heart pumps again all the cuffs deflate at the same time.
  • This enables the heart to pump into empty vessels, thus significantly reducing its workload and improves the ejection.

Do I need to get Hospitalized for EECP treatment?

No, its an out patient treatment.

Do I need to undergo Anaesthesia for EECP treatment?

No.