Treating Angina with EECP Therapy
The American Heart Association estimates that more than 6 million Americans are affected by angina, with more than 350,000 new cases diagnosed each year. Recent clinical trials, including the Multicenter Study of Enhanced External Counterpulsation (MUST-EECP), have shown EECP therapy to be safe and effective for the relief of chronic stable angina. 1,2
EECP is based on simple hemodynamic principles, wrapping pneumatic cuffs around the lower extremities and sequentially inflating those cuffs to provide diastolic augmentation to the coronary bed. Patients undergo 35, one-hour sessions during 4 to 7 weeks. The shear stress produced by the repeated cuff inflations appears to stimulate angiogenesis in the coronary bed, increasing the development of collateral circulation and making a natural "bypass." EECP is appropriate for patients with inoperable coronary artery disease, patients at high risk for interventions, and patients with recurrent angina despite medical therapy and revascularization.
As ongoing clinical trials are completed, the benefits and indications for EECP will most likely expand. NPs are in an ideal position to fully utilize this noninvasive, nonpharmacologic outpatient form of therapy.
Dean R. Humphreys,RN,MSN, FNP
Liverpool, New York
REFERENCESArora RR, Chou TM, Jain D, et al.: The multicenter study of enhanced external counterpulsation (MUST-EECP): the effect of EECP on exercise-induced myocardial ischemia and anginal episodes. JACC 1999; 33 ( 7 ): 1833-40. [Context Link]Lawson WE, Hui JC, Cohn PF: Long-term prognosis of patients with angina treated with enhanced external counterpulsation: five-year follow-up study. Clin Cardiol 2000; 23:254-8. [Context Link]
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