Enhanced External Counter Pulsation (EECP) is a treatment used in the management of angina. Angina is a condition characterized by chest pain caused when the heart receives insufficient oxygen. Several clinical pieces of research have confirmed that EECP is effective in the treatment of patients who have angina. Despite the clinical evidence, most cardiologists have not embraced EECP in their practice leading to the question of whether EECP is the right treatment for Angina. Various, more effective treatment options should be used before trying EECP. In essence, EECP is not the best treatment for angina.

What is Enhanced External Counter Pulsation (EECP?)

EECP is a mechanical process aimed at treating angina. In this procedure, lengthy inflatable cuffs resembling blood pressure cuffs are wrapped on the patient's legs. It is essential to ensure that the patient is comfortable. The cuffs are then inflated and then deflated simultaneously while being synchronized with the heartbeat. A computer is used to control both inflation and deflation. Inflation is matched with diastole while deflation is matched with the systole. During the process, inflation acts like it is pushing the blood from the lower to the upper parts of the legs in a manner that appears like milking. It is assumed that the process increases the blood flow and reduces the workload of the heart.

Harmful Effects of EECP

Studies have shown that EECP is not usually painful, and most patients tolerate this procedure; however, several patients have reported discomfort during EECP procedure. EECP is not the right treatment for angina because not every patient can undergo this procedure. Some patients can be adversely affected by EECP. A person who has aortic insufficiency or has undergone a recent cardiac catheterization should not be subjected to EECP. Individuals with irregular heartbeat such as atrial fibrillation cannot be treated using the EECP. People with other cardiac conditions such as high blood pressure and peripheral artery disease affecting the legs are also ruled out of EECP procedures. Someone who has a history of deep venous thrombosis is likely to be affected by EECP as well. People with angina may also be suffering from these conditions. This means that they will be not be subjected to an EECP procedure. If such individuals are referred for EECP, the procedure may be detrimental to the patients’ lives. In some cases, patients may not be aware that they have certain conditions and might go ahead and seek EECP medication, leading to adverse effects on the patient’s health.

The fact that EECP is recommended when all the other treatment options have failed shows that it is only useful as the last option where other safer interventions have failed. EECP is recommended when a person is not responding to all other medical treatment available for angina. Medicare does not approve the use of EECP unless the patient is not responding to all other treatments. Although this assumption is based on cost, the safety of the patient is a significant contributor in placing EECP as a last resort.


The exclusion of patients with certain conditions indicates that EECP is limited and may not be applicable in many cases. In case EECP is to be used, the patient must undergo extensive diagnosis to ensure that they do not have the conditions that limit the use of this procedure. The tests mean that the patient will incur additional charges that will be used to cover for the diagnosis. Medicare gives the directive to use EECP only when all the other available options have failed mainly because of the cost they incur while using this procedure. The cost does not come from the EECP itself but from the associated cost of diagnosing the patient to assess whether they are fit for the procedure. In resource strained nations, the stage of diagnosing other conditions before embarking on EECP could be bypassed, putting the patient at high risk of other complications.

EECP procedure requires 35 sessions in 7 weeks unlike other procedures such as inserting a stent that only takes about 30 minutes. This means that cardiologists will take a lot of time attending to a single patient, translating to wastage of time that could be used in taking care of other patients. It also means that more resources will be needed to pay specialists. In addition, the number of sessions will require payment from the patient or their insurance. The cost per session is about $280. While most insurance covers cater for EECP, some do not cover all the sessions, leaving the patient helpless after undergoing the initial sessions. This means that the patient will terminate the treatment without taking all the necessary sessions crucial for an ideal outcome.

How Does EECP Work?

The mechanism of action of EECP in the treatment of angina is not clear. The reason why cardiologists avoid EECP could be because nobody understands how the treatment works in treating angina. When a doctor decides to use EECP, it means that he/she is speculating on the intended outcome. Specialist prefers using treatments which they understand their mode of action. The mechanisms allow for troubleshooting in case something goes wrong during or after the procedure. The time taken by EECP is relatively higher than other tests that are more effective and take less time.

Although EECP is a noninvasive procedure and some patients have reported reduced symptoms of angina, this procedure is not reliable based on the lack of evidence on the process of healing. Using this treatment as the first option translates to a trial on patients who are suffering from serious conditions. It is only advisable to use ECCP when the other treatment options have failed, and the individuals can be entered in the trial program that seeks to understand the mechanism of action.


If the patient is being treated for angina without noticeable improvement, it is reasonable to try EECP rather than staying helpless. It is vital to consult the doctor and candidly discuss the possibility of EECP.

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