EECP is a guideline-recommended (ACC/AHA) outpatient option for refractory angina and selected heart failure. We handle intake, screening, treatment, and progress reporting, you stay in the loop without adding to your panel time.
FDA-cleared for stable and unstable angina, post-MI, and NYHA II-III heart failure. We screen every candidate for the predictors that actually drive response, anatomy, comorbidity, exercise tolerance, and motivation to complete 35 hour-long sessions.
Patients who remain symptomatic despite optimal medical therapy and are poor candidates for further revascularization. The clearest evidence base (MUST-EECP, IEPR) and the largest treatment effect.
PEECH trial cohort. We see meaningful gains in exercise capacity and quality-of-life metrics in compensated HFrEF patients who can sit through sessions without decompensation.
Patients with recurrent angina after surgical or percutaneous revasc, including graft disease, microvascular dysfunction, or anatomy not amenable to further intervention.
We screen out at intake, not in-chair. If your patient has any of the following, send them anyway and we’ll review with you, many cases are still workable.
Guideline-recommended in ACC/AHA/HFSA guidelines for refractory angina (Mehta et al., Circulation 2012); ESC Class IIa for refractory angina (2019). Full citation list on the Science page.
Five minutes of your time per patient. We handle the rest, insurance verification, scheduling, treatment, and progress notes back to your EMR within 24 hours of each session.
E-fax via your EMR or use our secure online form. Include the most recent H&P, last echo, last stress test or cath report, and current medication list. No special order set required.
Within one business day: candidacy review by our medical director, insurance benefit verification (Medicare and most commercial), and outreach to the patient to schedule a consult. We flag anything that needs your input before proceeding.
35 one-hour sessions, typically 5 days a week for 7 weeks. Vital signs and symptom diary at every visit. CCS class, NYHA class, and 6-minute walk recorded at baseline, week 4, and end of treatment.
Progress note after every 5 sessions to your fax / EMR. Final summary at week 7 with pre/post metrics. 6-month and 12-month follow-up letters with sustained-effect data. Direct line to our medical director for anything mid-course.
Drawn from the foundational EECP evidence base, the IEPR registry (Loh 2008, n=1,427), the MUST-EECP randomized trial (Arora 1999), and the Soran 2006 outcome analysis.
EECP is not a substitute for indicated PCI or CABG in obstructive disease. It’s an additive option for patients who are post-revasc with residual symptoms, or who are not candidates for further intervention (anatomy, comorbidity, prior surgical risk). ISCHEMIA-style data on stable angina supports the broader principle: medical & non-invasive strategies achieve comparable symptomatic outcomes to invasive ones in many stable patients.
IEPR registry data (Loh 2008) showed sustained CCS improvement, with benefit typically durable for 2–5 years in registry follow-up. Patients who experience symptom recurrence can be retreated, typically a shorter 17-session course is sufficient, and re-response rates are similar to first-course response.
Severe aortic regurgitation, decompensated heart failure, severe peripheral vascular disease (especially symptomatic claudication or non-healing wounds), recent DVT or active thrombophlebitis, uncontrolled hypertension (>180/110), bleeding diathesis or INR > 3.0, pregnancy. Relative contraindications: severe AS, recent cath (< 7 days), tachyarrhythmias not controlled, and irregular rhythms that prevent ECG-gating.
HCPCS G0166 (external counterpulsation). Medicare covers for refractory angina (NCD 20.20), Class III or IV, disabled despite optimal medical therapy, not candidates for revasc. Most commercial plans follow Medicare criteria. We verify benefits at intake and tell the patient and you what coverage looks like before treatment begins. Our patient-financial-services team handles prior-auth.
None demonstrated in adequately-powered RCTs. EECP is a symptom-modifying and quality-of-life-improving therapy, not a survival therapy. Mechanistic studies support plausibility (collateral recruitment, endothelial improvement), but the trial program was never sized for hard endpoints. We don’t claim mortality benefit, and we’d be cautious of anyone who does.
Start with MUST-EECP (Arora 1999), PEECH (Feldman 2006), and the Loh 2008 5-year follow-up. The Evidence section of our Science page has direct PubMed/DOI links to 6 foundational studies plus the ACC/AHA guideline citation. Email providers@flowtherapy.com if you want PDFs of any of them.
No surgery talk. No commitment. Just answers from the team that has helped 50,000+ patients regain energy, walk further, and feel like themselves again.
