Poster 41: Functional Status is Measurably Improved in Patients With Angina Treated With Enhanced External Counterpulsation

Abstract

Objective: To assess the effect enhanced external counterpulsation (EECP) has on overall functional status of individuals treated for angina. Design: Prospective cohort study with 6-month follow-up. Setting: Outpatient EECP clinic. Participants: 30 subjects (average age, 69.4y) with Canadian Cardiovascular Society (CCS) functional class III (n=21) and class IV (n=9) angina. Intervention: EECP utilizes electrocardiographic sequencing to trigger pneumatic cuffs wrapped around the lower extremities. The cuffs inflate and deflate during diastole, resulting in diastolic augmentation, increased venous return, presystolic unloading, and improved cardiac output. Main Outcome Measures: LIFEware System, a comprehensive, valid, and reliable tracking and reporting system for functional outcomes, and CCS functional angina classification. Results: 30 patients were assessed at baseline, after EECP, and at 6-month follow-up. At the conclusion of EECP patients rated their level of satisfaction with function and comfort achieved. Values ranged from 0 to 100 with the higher number referencing a better state, ie, more ability or less distress. Ratings at or above 70 were considered to define a prespecified threshold of clinical significance in functional status. Using that standard, 25 of 30 (83%) patients responded favorably to EECP. These responders reported considerable improvement in 4 variables: fatigue (mean, 41.0–59.8); satisfaction with life (mean, 45.5–68.2); social interactions (mean, 60.4–77.9); and role participation (mean, 63.2–78.8). At 6 months there was further improvement in the same four variables (mean, 76.6, 80.0, 83.2, and 86.8, respectively). CCS angina classification improved from a mean value of 3.36 to 1.24. Conclusions: EECP affords patients with angina significant improvement in quality of daily living, particularly in fatigue level, satisfaction with life, social interactions, and role participation. The overall functional status continues to improve 6 months after EECP is completed.