New Hope For Sick Hearts
Robert Turner of Chesterfield County, Va., has a long history of heart disease. Now 78 years old, Turner had coronary bypass surgery in 1972 and 1987. In 1992, he needed another operation, but surgeons decided the blockage was too difficult to reach. So the retired state education official enrolled in a clinical study of a noninvasive treatment in which a device squeezed and released parts of his legs and hips in conjunction with the beating of his heart. "I couldn't walk across the room before having the treatment," Turner says, but after seven weeks of daily, hour-long sessions, "I was up to a mile a day."
The treatment is called enhanced external counterpulsation, or EECP, and the idea behind it is to boost blood flow to the heart and possibly precipitate the growth of additional blood vessels around arterial blockages. The U.S. Food & Drug Administration approved the procedure in 1995 for angina, or chest pain, when treatments such as medication, surgery, and angioplasty have failed or are not medically feasible. But FDA approval doesn't mean the procedure is universally accepted by doctors, and critics point out that despite testimonials such as Turner's, there is no conclusive evidence that the treatment works.
EECP is offered at 150 cardiac care centers nationwide, including those associated with the Mayo Clinic and Columbia University. Medicare and some private insurers have begun covering the cost, which can run from $7,000 to $9,000 for 35 sessions--five days a week over seven weeks.
During the treatment, the patient lies on a table with what resembles three large blood-pressure cuffs encircling the calves, thighs, and buttocks. Three electrodes go on the chest to monitor the heart's rhythm, and a thimble-like blood-pressure sensor is placed on one finger. Then, for about an hour, the cuffs sequentially inflate, moving upward, and rapidly deflate in reverse order. The cycle is synchronized so that inflation occurs when the heart is between beats and, thus, receptive to maximal blood flow. Deflation happens when the heart contracts. The release of pressure causes blood to rush out from the heart into the body, much like water spurting from a hose after you've straightened a kink. The hoped-for effect is better circulation.
Studies on EECP's efficacy have been positive, but most have been small and observational. A larger clinical study showed patients had only a slight improvement in objective measurements, such as treadmill tests. "There's just not enough hard evidence to prove that this is an effective therapy," says Dr. Richard Stein, a cardiologist and a spokesman for the American Heart Assn.
Yet anecdotal reports from patients are compelling. Although few have as dramatic a recovery as Turner, most show marked improvement in their ability to do everyday tasks, such as grocery shopping. They suffer from fewer episodes of disabling chest pain and take less nitroglycerin. "No one can really explain it, but there's definitely something to this treatment, and that's why more hospitals are starting to offer it," says Dr. Gordon Fung, co-director of the EECP program at the University of California at San Francisco. Indeed, the renowned Texas Heart Institute in Houston and Cleveland Clinic will have EECP programs in place by 2001.
While doctors debate its benefits, EECP doesn't seem to have any downside, except that it's costly and time-consuming. The only reported side effect is mild chafing. "The thinking is that it may help, and it certainly won't hurt," says Dr. Ian Sarembock, director of the coronary care unit of the University of Virginia Health System in Charlottesville. For those patients who can't or don't want to have the standard treatments, EECP may be worth considering.
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