Background

Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimized medical therapy. Recurrent angina symptoms are strongly associated with psychological distress and cardiac anxiety (i.e., a subtype of anxiety related to cardiac sensations). Enhanced external counterpulsation (EECP) is an alternative non-invasive treatment for these patients. An EECP course includes 35 1-hour sessions over 7 weeks. No previous study has explored long-term EECP effects on cardiac anxiety in patients with RAP.

Objective

To evaluate the effects of EECP treatment in patients with RAP regarding usage of nitrates, physical capacity, cardiac anxiety and HRQoL.

Methods

A quasi experimental design with long-term follow-up (6 months) involving 50 patients (men=37, 47–91 years) who had finished one course of EECP. Assessment of average use of nitrates, six-minute walk test, functional class with Canadian Cardiovascular Society (CCS) classification and questionnaires for cardiac anxiety and HRQoL were collected pre and post treatment. In addition, the questionnaires were collected 6 months after completion of EECP.

Results

Patients used significantly less nitrates (p<0.001) compared to at the start of treatment. They enhanced the walking distance on average by 46 m after EECP (p<0.001) and CCS class also improved (p<0.001). All subscales except for one in cardiac anxiety were significantly reduced (p<0.05). All dimensions in HRQoL improved significantly (p<0.01). The positive effects in both cardiac anxiety and HRQoL were maintained 6 months after the treatment.

Conclusions

Patients with RAP received beneficial effects from EECP. Reduced symptom burden and improved physical capacity enable engagement in physical activities. Furthermore, less cardiac anxiety and improved HRQoL may enhance life satisfaction for these patients. EECP treatment should be considered to a greater extent to improve the life situation for these patients.