Can EECP Treatment, a noninvasive bypass therapy, fill the gap between Heart Patients & Specialists?
With the rise in the number of heart patients in India and limited resources to take care of them, can EECP Treatment, a noninvasive heart bypass therapy, bridge the gap between heart patient care & heart super-specialists; reduce mortality and morbidity and improve the quality of life?
In India, with a population of 1.3 Billion and a prevalence of about a 35-40 million people suffering from compromised cardiac (heart) health, there are:
- Only 1500 Cath labs
- Only 5000 Super specialist Cardiologists.
- Only about 1500-2000 Cardio-thoracic surgeons in about 160-170 centers operate on about 70,000 to 1 lac patients every year.
The addition of even 200 Cath labs every year is not enough to deal with the newly added Cardiac Patients (Heart Patients).
There is an increasing gap between the demand and supply in managing Heart ailments (including Coronary Artery Diseases) because of the following reasons:
1. Interventional Cardiac management like Angioplasty and CABG need skilled Interventional Super specialist cardiologists and Cardiothoracic Surgeons.
2. The statistics mentioned above (number of Cath labs, Superspecialist Cardiologists, CVTS Operation theaters, Superspecialist Cardiothoracic Surgeons) are not favorable considering the massive load of the disease and fewer service providers.
3. The modern lifestyle and stresses further contribute to the increased incidence of Coronary Artery Disease.
4. Chronic nature of Cardiac (Heart ailments) needs lifelong care, and the prevalence keeps rising.
Do we need newer modalities to take care of heart patients?
In the current scenario, the existing Cardiac health infrastructure is insufficient to handle the chronic cases of Heart ailments. There is a need for Consultant physicians with a specialty in Medicine (M.D.; Medicine) to come ahead and build a support system for the super-specialists (D.M.; Cardiology and M.Ch.; Cardiothoracic Surgery). It is critical to managing these chronic cases of Heart diseases (including Coronary Artery Diseases) effectively in a timely fashion.
In this ecosystem, the super-specialists would be working inside the Cath labs and CVTS operation theaters and do Angioplasties, CABG, and other cardiovascular interventions, and the Consultant Physicians take care of these patients later and support them lifelong. As the demand and supply of the Cardiac infrastructure are imbalanced, the acute cases (new cases) need immediate interventions; the super-specialists will find themselves more involved in Interventional procedures to meet the demand because of the rising incidence of Heart ailments (including coronary artery diseases).
The consultant physicians with the vast knowledge of Internal and Systemic Medicine have the responsibility to take care of these patients, improve their quality of life and decrease the burden of polypharmacy. One such approach can be the addition of noninvasive therapy procedures like EECP to their setup.
What is EECP Treatment?
EECP stands for Enhanced External Counter Pulsation. The best part is that EECP is an outpatient department or OPD-based procedure and does not require hospitalization, although a monitoring period and physician supervision are necessary. It works on the principle of Diastolic Augmentation, which increases coronary blood flow during Diastole and opens the collateral circulation in the Heart.
How many sessions of EECP Therapy are required?
EECP is popularly known as the Natural Coronary Bypass procedure (though it is a misnomer). Usually, 40 sessions are required once daily for 40-50 minutes to achieve optimal results. The outcome may not be identical and depends on a case-to-case basis. Careful pre-EECP clinical evaluation, realistic expectations, and correct selection of candidates for EECP Therapy help avoid patient and clinician dissatisfaction.
Who can benefit from EECP Treatment?
1. Having blockages in their heart blood vessels but not significant enough for interventions like Angioplasty and Bypass surgery.
2. Having symptoms even after getting their procedures done (Angioplasty or CABG).
3. Having significant blockages in their heart blood vessels but are unfit for surgery.
4. Are advised to redo Angioplasty or CABG.
5. Waiting for their Angioplasty or CABG for any reason.
6. Having heart failure and symptoms not improving despite being on multiple medicines.
7. Have fear or anxiety about going for any invasive intervention.
Why are patients not receiving EECP Therapy?
It is a matter of great concern that the patients who, for whatever reason, are either not fit or not willing to undergo the invasive intervention despite all the explanations are left alone without offering them a noninvasive intervention like EECP therapy. Clinicians and patients do not have enough information about EECP treatment, which is the only plausible explanation. However, the truth remains that select qualified heart patients may benefit from EECP treatment.
Special thanks to Dr. Asmita Chaturvedi, MD, Medicine, Physician Consultant, Clinical Cardiologist, and EECP treatment provider for her valuable input. Dr. Asmita has conducted numerous EECP procedures and has extensive experience in this procedure in Mumbai, India.
Dr. Deepak Chaturvedi, MD, Medicine.