Improved external counterpulsation therapy benefits long COVID-19 patients

In a small study of long-term COVID-19 patients, patients with and without coronary artery disease showed improvement in a variety of symptoms, including fatigue, breathing difficulties, and chest discomfort, after undergoing 15-35 hours of enhanced external counterpulsation therapy (EECP). The study will be presented at the American College of Cardiology Cardiovascular Summit virtual conference, February 16-19, 2022.

EECP is a non-invasive technique that has been shown to improve cardiac and cerebral perfusion. Patients undergoing EECP arrive at the clinic, lie on a treatment table, and are fitted with three sets of pneumatic cuffs on the calves, thighs, and lower hips. A 3-lead electrocardiogram is used as the mechanism for the cuffs to inflate sequentially from the calves to the hips during the resting phase of the heart. With the start of the contraction phase of the heart, the cuffs deflate at the same time. This prescribed inflation and deflation pushes oxygen-rich blood through the heart muscle and the rest of the body. A patient is treated for one hour, with up to 35 treatment sessions over the course of seven weeks.

“New data show that Long COVID is a disease affecting vascular health, also known as endothelial function. EECP is a disease-modifying, noninvasive therapy previously shown in controlled clinical trials to improve endothelial function,” said Sachin A. Shah, PharmD, senior author of the study and chief scientific officer at Flow Therapy, a nationwide EECP Provider headquartered in Ft. Worth, Texas. “We currently believe this is the most plausible explanation for the benefits of EECP and its connection to long-COVID.”

Globally, an estimated 50% of COVID-19 patients have persistent symptoms six months after the acute phase of COVID-19 infection, with long-term symptoms varying in severity.

Several of our patients were disabled to the point of being unable to work. Remarkably, at this point all patients were able to successfully return to work after treatment. These patients also showed improvement in “brain fog,” which is a common symptom of long COVID. We look forward to further analyzing and sharing this data in the future.”

Sachin A. Shah, PharmD, senior author of the study

Researchers included 50 long COVID patients (54 ± 15 years old) who were referred to a Flow Therapy provider for EECP treatment in a retrospective analysis, including 30 patients with no history of coronary artery disease and 20 patients with coronary artery disease (CHD). All patients were evaluated before and after EECP therapy using the Seattle Angina Questionnaire-7 (SAQ7), Duke Activity Status Index (DASI), PROMIS Fatigue Instrument (PROMIS), Rose Dyspnea Scale (RDS), and the 6-minute -Walk test (6MGT).

“These tests were used as they are all validated tools accepted by the International Consortium for Health Outcomes Measurement to assess fatigue, breathing difficulties and chest discomfort,” Shah said.

“They have been used in clinical trials to assess disease burden and are associated with morbidity and mortality benefits,” he said.

The analysis revealed statistically significant improvements across all validated testing tools:

  • Health improved by 25 points using the SAQ7 tool (range 0-100)
  • Functional capacity improved by 20 points according to DASI assessment (range 0-58.2)
  • Fatigue levels reduced by 6 points using the PROMIS score (range 4-20)
  • Shortness of breath using the RDS decreased in 50% of patients
  • Increased walking capacity (6 MWT) by 178 ft in 6 minutes

The researchers found that the change from baseline for long COVID patients was significant only for all endpoints and no difference was apparent between long COVID patients without CAD compared to patients with CAD.

The researchers believe that larger studies with a sham control group are warranted to further validate these results.


American College of Cardiology

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