Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life

Eur J Cardiovasc Nurs. 2013 Oct;12(5):437-45. doi: 10.1177/1474515112468067. Epub 2012 Dec 21.


Background: Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients.

Aims: The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP.

Methods: This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up.

Results: Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment.

Conclusion: Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

Keywords: Refractory angina pectoris; enhanced external counterpulsation; health-related quality of life; physical capacity.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angina Pectoris / nursing
  • Angina Pectoris / physiopathology
  • Angina Pectoris / therapy*
  • Cardiovascular Nursing / methods*
  • Counterpulsation / nursing*
  • Counterpulsation / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Physical Endurance / physiology*
  • Pilot Projects
  • Prospective Studies
  • Quality of Life*
  • Self Report
  • Surveys and Questionnaires
  • Walking / physiology