EECP Therapy Advantages and Disadvantages

While not a mainstream treatment, EECP can reduce symptoms of angina

Enhanced external counterpulsation (EECP) therapy is a non-invasive mechanical treatment that can help reduce the symptoms of angina, or chest pain. EECP uses inflatable cuffs on the lower limbs to create pressure and encourage better blood flow.

Clinical studies have shown that EECP treatment can help decrease symptoms of angina in people with coronary artery disease (CAD) who, due to underlying health issues, are not good candidates for surgery. Major medical organizations suggest considering EECP treatment for those with angina who are not helped by other options.

This article explains how EECP therapy works and its effectiveness and risks. It also covers when healthcare providers recommend it.

Doctor and patient talking
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What Is EECP?

EECP is a mechanical procedure in which long inflatable cuffs (like blood pressure cuffs) are wrapped around both of the patient’s legs. While the patient lies on a bed, the leg cuffs are inflated and deflated in tandem with each heartbeat.

The inflation and deflation are controlled by a computer, which uses the patient’s electrocardiogram (ECG) to trigger inflation early in diastole (when the heart relaxes and is filled with blood), and deflation just as systole (heart contraction) begins.

The inflation of the cuffs occurs sequentially, from the lower part of the legs to the upper, so that the blood in the legs is “milked” upwards, toward the heart.

EECP is approved by the Food and Drug Administration. It involves a series of outpatient treatments. You'll receive five one-hour sessions per week for seven weeks. The 35 sessions are aimed at provoking long-lasting beneficial changes in the circulatory system.

EECP Therapy Benefits

Some evidence suggests EECP can help induce the formation of collateral (small) blood vessels in the coronary artery system. It stimulates the release of key chemicals within endothelium tissue that lines the coronary arteries.

There's also evidence that EECP treatment may act as a form of “passive” exercise, leading to the same sorts of lasting beneficial health changes that are seen with real exercise.

EECP therapy has at least two potentially beneficial actions on the heart:

  • First, the milking action of the leg cuffs increases the blood flow to the coronary arteries during diastole. (Unlike other arteries, coronary arteries receive their blood flow in between heartbeats, not during them.)
  • Second, by deflating just as the heart begins to beat, EECP creates something like a sudden vacuum in the arteries. This reduces resistance in the blood vessels of the legs so that blood can be pumped more easily from your heart, and may also help reduce endothelial dysfunction.

EECP also may improve peripheral arterial function, which serves to reduce the oxygen demand on heart muscle.

EECP and COVID-19

Roughly 50% of people diagnosed with COVID-19 still have lingering symptoms six months after recovery from the initial infection. For some, this "long COVID" related to blood vessel damage has serious impacts. Some reports, including a study of 50 people with long COVID, suggest EECP can offer benefits to improve health, recovery, and quality of life.

How Effective Is EECP Therapy?

Several studies suggest that EECP therapy can be quite effective in treating chronic stable angina.Some have shown that improvement in symptoms seems to persist for up to five years (though some patients may require another course of EECP to maintain their improvement).

The effects of EECP also are being studied for treating other conditions, such as diabetes and heart failure.

One review of 823 cases included in eight different studies found that EECP can improve physical exercise tolerance and certain heart functions in people living with heart failure, but more study is recommended.

When EECP Is Recommended

EECP therapy may be considered for anyone who still has angina despite maximal medical therapy, and in whom stents or bypass surgery are deemed not to be good options.

Medicare has approved coverage for EECP for patients with angina who have exhausted all their other choices.

In 2014, several professional organizations finally agreed in a focused update that EECP treatment ought to be considered for patients with angina that's not helped by other treatments. These organizations are:

  • The American College of Cardiology
  • American Heart Association
  • American Association for Thoracic Surgery
  • Preventive Cardiovascular Nurses Association
  • Society for Cardiovascular Angiography and Interventions
  • The Society of Thoracic Surgeons

EECP isn't for everyone, but you may want to consider it if you are diagnosed with angina and your cardiologist's assessment for treatment does not include surgery. You also may want to ask a healthcare provider about its emerging uses for other conditions, such as long COVID care.

EECP Therapy Contraindications

EECP can be somewhat uncomfortable but is generally not painful. In studies, the large majority of patients have tolerated the procedure quite well.

However, not everyone can have EECP therapy. You probably should not have EECP if you have:

Why Isn’t EECP Used More Often?

Your cardiologist may not have offered EECP treatment to you for several reasons, including your underlying health history and specific treatment plan. It's not considered a first-line treatment for angina, even though it can decrease the need for common medications like nitroglycerin.

Treatment availability also may be a factor, because not all communities have accessible EECP equipment. Travel time can be a barrier to keeping appointments and completing the necessary full course of EECP treatment.

The EECP option has become more common in the United States in the past 10 years, though, and about 1,200 machines are now in operation across the country.

Talk to your healthcare provider about the possibility for EECP treatment for stable angina. It may be an option because:

  • It's safe and well tolerated
  • It's supported by available evidence (albeit imperfect) that strongly suggests the treatment is quite effective in many cases
  • Those being treated can tell pretty definitively whether it substantially reduces angina symptoms

What Is the EECP Treatment Cost?

The cost of EECP treatment will vary, depending on factors such as where you live and the type of insurance coverage you have. It's about $4,880 for a full treatment when billed to Medicare and is now covered under many private healthcare plans.

Summary

Enhanced external counterpulsation (EECP) therapy is a safe and effective alternative to surgery when treating angina (chest pain) in people with coronary artery disease. It may have uses for other conditions that remain under study, including heart failure, diabetes, and long COVID.

EECP works by using inflatable cuffs to apply pressure to your lower legs. The pressure is synchronized to your heartbeat to improve blood flow and heart function.

While EECP is not an option for everyone, such as those with a pacemaker, it is increasingly available in the United States. It's also a comparatively affordable treatment. Talk to your cardiologist to learn more about whether EECP treatment is an option for you.

Frequently Asked Questions

  • Who is eligible for EECP?

    If you have had prior treatment for angina but still require further treatment, you may be eligible for EECP therapy. In addition, if you are not a candidate for surgery, you are likely eligible for EECP.

  • Is EECP a substitute for heart surgery?

    While EECP therapy can be a good alternative for people who are not good candidates for stents or bypass surgery, it is not a replacement for those who can have surgery. EECP cannot correct blocked arteries like surgery can.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Arora RR, Chou TM, Jain D, et al. The Multicenter Study of Enhanced External Counterpulsation (MUST-EECP): Effect of EECP on Exercise-Induced Myocardial Ischemia and Anginal Episodes. J Am Coll Cardiol 1999; 33:1833.

  • Fihn SD, Blankenship JC, Alexander KP, et al. ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64:1929.

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.