Poster 23: Enhanced external counterpulsation and functional improvement in octogenarians with symptomatic ischemic heart disease

Abstract

Objective: To assess the functional outcomes of octogenarians with angina who receive enhanced external counterpulsation (EECP). Design: Retrospective review. Setting: Outpatient cardiac treatment facility. Participants: 24 octogenarians (avg age, 84.75y) with Canadian Cardiovascular Society (CCS) functional class III angina. Interventions: EECP is a safe, noninvasive outpatient therapy that uses computerized electrocardiographic sequencing to trigger pneumatic cuffs wrapped around the lower extremities. These cuffs sequentially inflate during diastole and rapidly deflate just prior to systole, resulting in diastolic augmentation, presystolic unloading, increased venous return, and improved cardiac output. The clinical outcomes of EECP therapy include marked symptom reduction and improved exercise tolerance in nearly 80% of patients. Main Outcome Measures: CCS angina classification and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: Our patients received an average of 38.75 hours of EECP therapy and reported no adverse events. 23 of the 24 patients improved their CCS angina classification by at least 1 class (8 by 2 classes) and 3 patients were entirely asymptomatic by the end of the program. All patients demonstrated improvement in exercise tolerance and functional status. The SF-36 was used to assess functional outcomes. The improvement in physical functioning ( P<.015) and emotional role ( P<.003) were statistically significant. The improvements in perception of health status was also significant ( P<.0001). Conclusions: EECP is a safe, efficacious treatment alternative for octogenarians with angina. This therapeutic physical modality leads to significant functional improvement, particularly in mobility and emotional outlook, in octogenarians with symptomatic ischemic heart disease and should be considered readily as a treatment option for this high-risk population.