Background: Despite optimal pharmacological treatments and invasive procedures, patients with refractory angina pectoris (RAP) remain symptomatic. Enhanced External Counterpulsation (EECP) is a non-invasive therapy based on 35 one-hour sessions. External pneumatic cuffs wrapped around the patient’s lower extremities inflate during cardiac diastole to create retrograde diastolic counterpulsation which leads to an improved coronary perfusion. EECP has for the past decade been used in European countries and has recently been updated in the European Guidelines as a clinical treatment option for patients with RAP.

Purpose: The purpose was to describe the design and outcome variables of studies using EECP as a treatment for RAP.

Methods: Search methods: Databases (i.e., PubMed,Wiley Online Library, Science Direct) were used to identify abstracts, reviews and journal articles related to this subgroup and EECP. Selection criterias: The chosen key words were EECP and refractory angina pectoris. Between time period 2000 to October 2016. Data collection and analysis: The literature search resulted in a total of 155 hits. Detected duplicates, irrelevant studies and others (i.e., editorials, letters) were removed (n=75). Research area and study design were reviewed in all remaining articles (n=80). In 56 of these, where design and content allowed, further analyses regarding follow-uptime and outcomes variables were performed.

Results: An uneven distribution regarding research area was found among the analysed papers with dominance (48%) of studies within medicine and biology. Only 12% of the studies were performed within nursing. Prospective and longitudinal designs dominated (47%). Out of eight retrospective studies five were registry studies. Only two studies used a RCT design. No study used a qualitative approach. Out of 24 prospective studies 18 (75%) had a follow-up of 12 months or longer. 52% used biomedical outcomes (i.e., hemodynamic, biomarker, arterial stiffness, peripheral vascular reactivity) and 41% used clinical/patient reported outcomes (i.e., quality of life, functional classes, physical capacity, psychological aspects). Cost effectiveness was calculated in 7% of the studies.

Conclusions/implications: EECP is recommended in guidelines as a possible treatment for patients with RAP. There is, however, a great need for increased nursing research both with qualitative and quantitative approaches. RCTs are sparse, as well as cost-effectiveness-studies.