Enhanced External Counterpulsation Improves Exercise Duration and Peak Oxygen Consumption in Older Patients With Heart Failure: A Subgroup Analysis of the PEECH Trial

Abstract

The Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure (PEECH) trial demonstrated that enhanced external counterpulsation (EECP) therapy increased exercise duration and improved functional status and quality of life without affecting peak oxygen consumption. The authors present data from a prespecified subgroup of elderly patients (65 years or older) enrolled in the PEECH trial. The 2 co‐primary end points were the percentage of subjects with a >60‐second increase in exercise duration and the percentage of subjects with a >1.25‐mL/kg/min increase in peak volume of oxygen consumption. At 6‐month follow‐up, the exercise responder rate was significantly higher in EECP patients compared with controls (P=.008). Further, in contrast to the overall PEECH study, the EECP group demonstrated a significantly higher responder rate for peak oxygen consumption (P=.017). The authors conclude that an older subgroup of PEECH subjects confirms the beneficial effect of EECP in patients with chronic, stable, mild‐to‐moderate heart failure.

Expert consensus on the clinical application of enhanced external counterpulsation in elderly people (2019)

“…Its results showed that EECP improved exercise tolerance, cardiac function and quality of life, but not maximal oxygen intake at six months of follow‐up. Subgroup analysis further showed that among patients >65 years of age, maximal oxygen intake was increased after EECP treatment, indicating a greater extent of benefit for the elderly patients . Beck et al reported that EECP improved vascular endothelial dysfunction, peripheral vascular resistance, myocardial perfusion, peripheral vascular function and exercise tolerance among patients with coronary artery disease and left ventricular dysfunction.…”

“…It improves organ ischemia through a series of protective mechanisms. EECP was first introduced in the treatment of angina and was subsequently applied in various conditions including heart failure, ischemic cerebrovascular diseases and so on, with documented evidence of benefits . Improvements in diabetes, ischemic eye diseases, sudden hearing loss, male erectile dysfunction, sleep disorders, etc have also been reported .…”

The Role of Enhanced External Counter Pulsation Therapy in Clinical Practice

“…A subgroup analysis of patients over age 65 from the PEECH trial (EECP n=41, control n=44) demonstrated a 6-month higher response rate in the peak VO2 group compared to the control group (29.7% vs 11.4%, P=0.017). 20 The PEECH 20 trial further demonstrated that 33.3% of patients showed improvement of at least one class of New York Heart Association (NYHA) classification 1-week post-EECP therapy, with 31.3% of patients reporting improvement in classification 6-months post-therapy. Of note, 11.4% and 14.3% of placebo patients reported the same results, respectively.…”

“…Both randomized-controlled trials (MUST-EECP 9 and PEECH 20 ) received sponsorship from Vasomedical, the EECP manufacturer. These studies included patients with chronic stable angina, and refractoriness to standard anginal treatment was not a mandatory requirement.…”

“…19 The Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart failure (PEECH) 20 trial of 187 subjects with stable, symptomatic, mild-to-moderate heart failure (left ventricular ejection fraction [LVEF] ≤35 %) on optimal medical management demonstrated a significant increase in exercise time of at least 60 seconds in the EECP group (35%) compared to control group (25%), with a significant improvement of the Minnesota Living with Heart Failure score at 1 week and 3 months after treatment. There was no significant difference in the peak VO2 between the groups.…”