User talk:Vasomedicaleecp

- 	EECP (Enhanced External Counter Pulsation) Therapy is an FDA cleared, Medicare approved, non-invasive medical therapy for the treatment of stable and unstable angina, congestive heart failure, acute myocardial infarction, and cardiogenic shock. Hemodynamically, EECP Therapy improves cardiac output, increases circulation, recruits and develops new collaterals. It also increases shear stress on the endothelium, improving endothelial function, reduces circulating inflammatory markers and arterial stiffness, while also inhibiting smooth muscle cell proliferation and migration. EECP Therapy is currently available in more than 600 locations throughout the United States, as well as over 35 countries around the world. More than 150 peer-reviewed papers have been published demonstrating EECP to be safe and effective in the treatment of angina and chronic heart failure. - 		 -

History
- 	EECP is a registered trademark for the external counterpulsation therapy (ECP) and equipment of Vasomedical Inc., Westbury, NY. Only Vasomedical may use the trademarked name for its proprietary Enhanced External Counterpulsation therapy. - 		 - 	EECP is more than just a trademark. It stands for Enhanced External Counterpulsation, a term coined in the 1990’s by Dr. John Hui, a founder of Vasomedical, and his collaborators to describe an improved, proprietary technology for better ECP therapy. - 		 - 	External counterpulsation (ECP) is a generic term for a circulatory assist technique first introduced by Drs. Harken, Birtwell and Soroff in the 1960's using a hydraulic (water) driven system with a single bladder encasing the lower extremities to produce diastolic augmentation and systolic unloading. With this hydraulic form of ECP system, a handful of clinical researchers conducted clinical studies in the areas of stable angina, acute myocardial infarction and cardiogenic shock. Some of these studies were positive and some were equivocal due to the limitations of the technology available at the time. While pneumatic ECP systems started to appear in the 1970’s and 1980’s, their performance was still not satisfactory. - 		 - 	Using the direct teachings from the inventors of external counterpulsation, together with a unique knowledge of hemodynamics and pathophysiology drawn from their experience and scientific evidence, Dr. John Hui, the last Fellow of Dr. Clifford Birtwell, and his team at Vasomedical redesigned the external counterpulsation system with sequential application of external pressure to three sets of pneumatic cuffs wrapped around the calves, lower thighs and upper thighs/buttocks to increase treatment efficiency. With the state-of-the-art electronics, patented valve design and proprietary software, the new system significantly improved the delivery and outcomes of the therapy with optimal timing and profile of cuff pressurization. - 		 - 	To differentiate this new system from the other ECP systems, Dr. Hui and his colleagues at Vasomedical called this technology Enhanced External Counterpulsation or EECP. Over the years, the technology has been continuously improved to take advantage of the latest scientific and clinical developments as well as technological advancements. - 		 - 	The first paper describing the modern era of enhanced external counterpulsation was published in 1992 by Drs. Lawson, Soroff, Zheng and Hui using the term EECP for the first time to describe the enhanced features of external counterpulsation exclusively manufactured and trademarked by Vasomedical. Since then, more than 160 clinical and scientific papers have been published in medical journals and approximately 200 presentations in major scientific conferences, reporting results of clinical studies using EECP systems exclusively. - 		 -

EECP Therapy Delivery
- 	The EECP system consists of three sets of inflatable pressure cuffs wrapped around the calves and the lower and upper thighs, including the buttocks. In synchronization with each cardiac cycle, obtained with an integrated 3-lead ECG, the cuffs are sequentially inflated from the calves to the buttocks during diastole to produce an arterial retrograde flow towards the aortic root to increase coronary blood flow. EECP simultaneously increases venous return to raise cardiac output. The cuffs are deflated simultaneously before the onset of systole to provide an empty vascular space, reducing systemic vascular resistance in the lower extremities to receive blood ejecting from the heart, significantly reducing the workload and oxygen demand of the heart. - 	- 		 -

Patient Selection
- 	EECP Therapy is primarily used as a non-pharmacologic outpatient treatment for patients with chronic stable angina (chest pain, atypical pain, shortness of breath, fatigue, and cough) as well as the symptoms of heart failure. Patients with severe, diffuse coronary atherosclerosis and persistent angina, or significant silent ischemia burden, such as elderly patients and those with diabetes, challenging coronary anatomies, or debilitating heart failure, renal failure, or pulmonary disease, have also been shown to derive benefit from EECP Therapy. EECP Therapy has also been shown to be effective in relieving angina symptoms in patients with Cardiac Syndrome X. Benefits of EECP have also been determined in the management of angina in the elderly, angina patients with left main disease, and in patients with mild refractory angina (CCS Class II). EECP Therapy is equally effective in reducing angina symptoms in patients with or without diabetes, and in patients with all ranges of body mass index. - 		 - 	EECP Therapy has also been shown to improve exercise capacity in heart failure patients with NYHA Class II/III and in exercise peak oxygen consumption in older patients with heart failure. EECP Therapy has also been demonstrated to be equally effective in providing symptomatic benefits in angina patients with either systolic or diastolic heart failure. For patients with left ventricular dysfunction, EECP Therapy has been shown to sustain the initial benefits for up to 3 years. - 		 -

Contraindications
- 	EECP Therapy should not be used for the treatment of patients with: - 	- 	- 	- 	- 	- 	- 		 -
 * Arrhythmias that interfere with machine triggering,
 * Bleeding diathesis,
 * Active thrombophlebitis,
 * Severe lower extremity vaso-occlusive disease,
 * Presence of a documented aortic aneurysm requiring surgical repair,
 * Pregnancy.

Precautions
- 	- 	- 	- 	- 		 -
 * Patients with blood pressure higher than 180/110 mmHg should be controlled prior to treatment with EECP.
 * Patients with a heart rate more than 120 bpm should be controlled prior to treatment with EECP.
 * Patients at high risk of complications from increased venous return should be carefully chosen and monitored during treatment with EECP. Decreasing cardiac afterload by optimizing diastolic augmentation may help minimize increased cardiac filling pressures due to venous return.
 * Patients with clinically significant valvular disease should be carefully chosen and monitored during treatment with EECP. Certain valve conditions, such as significant aortic insufficiency, or severe mitral or aortic stenosis, may prevent the patient from obtaining benefit from diastolic augmentation and reduced cardiac after-load in the presence of increased venous return.

Mechanisms Of Action
- 	There is evidence demonstrating improved endothelial function via the hemodynamic effects by the increased shear stress acting on the arterial wall, reducing arterial stiffness and providing protective effects against inflammation, inhibiting intimal hyperplasia and the atherosclerotic process. - 		 - 	- 		 - 	There is also evidence that EECP Therapy triggers a neurohormonal response that induces the production of growth and vasodilatation factors, which together with the increased pressure gradient created across the occlusive site during EECP Therapy, promotes recruitment of new arteries, while dilating and normalizing the function of existing blood vessels. The collaterals bypass stenoses and increase blood flow to ischemic areas of the heart, leading to improved clinical outcomes. - 		 -

Suggested Treatment Protocol
- 	The treatment is administered to patients on an outpatient basis, usually in daily one-hour sessions, five days per week over seven weeks for a total of 35 treatments. EECP is equally effective if it is given twice daily, each with - 	one-hour session separated by a minimum of 30-minutes break for a total of three and a half weeks. The procedure is well tolerated and under this suggested protocol, approximately 75% of patients experience relief of symptoms caused by their coronary artery disease following the course - 	of treatment. - 		 -

Clinical Evidence
- 	Since 1992, there have been more than 150 papers published in peer reviewed medical journals demonstrating EECP Therapy as a non-invasive, safe, low-cost and highly effective treatment for patients with coronary artery disease. There are 8 randomized controlled trials (RCT) documenting the clinical outcomes and mechanisms of action of EECP Therapy. The most well- known RCTs were the Multicenter Study of EECP (MUST-EECP) in the treatment of patients with angina pectoris and Prospective Evaluation of EECP in Congestive Heart Failure (PEECH™) study. There is also a subgroup study analyzing data from the PEECH™ trial for heart failure patients age 65 or older. - 		 - 	- 		 -

International EECP Patient Registries
- 	There are two International EECP Patient Registries, (IEPR I with 5,000 patients and IEPR II with 2,500 patients) which were maintained at the Epidemiology Data Center of the University of Pittsburgh and completed in July 2001 and Oct 2004 respectively. This determined the patterns of use, safety and efficacy of EECP for a period up to 3 years post treatment. Data collected were patients’ demographics, medical history, CAD status, quality of life, CCS Classification, medication, angina frequency and adverse clinical events before EECP, post EECP, and during follow-up periods. - 		 - 		 -

Reimbursement
- 	Currently, the Centers for Medicare and Medicaid Services (CMS) and many commercial third-party insurance payers have provided coverage of EECP treatment for patients who have been diagnosed with disabling angina (Class III or Class IV, Canadian Cardiovascular Society Classification or equivalent classification) who, in the opinion of a cardiologist or cardiothoracic surgeon, are not readily amenable to surgical intervention, such as PTCA or cardiac bypass because: - 	(1) Their condition is inoperable, or at high risk of operative complications or post-operative failure, - 	(2) Their coronary anatomy is not readily amenable to such procedures; or - (3) They have co-morbid states, which create excessive risk. - 		 - 	Patients with a primary diagnosis of heart failure, diabetes, peripheral vascular disease, etc. are also eligible for reimbursement under the current coverage policy, provided the primary indication for treatment with EECP Therapy is angina or angina equivalent symptoms and the patient satisfies other listed criteria. - 		 - 		 -