Comparison between Medical Management, Enhanced External Counterpulsation (EECP) and Cardiac Resynchronization Therapy (CRT) in Heart Failure

Introduction- The clinical syndrome of heart failure (HF) remains a leading cause of cardiac morbidity and mortality. The coming years will see a continuous growth in the epidemic of HF and increasingly complex pharmacological, interventional, and device-based therapies, effective in reducing HF morbidity and mortality. Highly trained clinician-specialists are needed to assist in optimally evaluating and managing patients with HF. Objective- The aim of the present study was to determine the best management protocol for HF by surveying different therapeutic protocols (medical, cardiac resynchronization therapy [CRT] program, and enhanced external counterpulsation [EECP]). Methods- Initial assessment was performed for a total of 280 HF patients evaluated in the Heart Failure Clinic. Eighty patients were included in the study; the selection being done in accordance with the inclusion criteria of ejection fraction (EF) 35%. By surveying different therapeutic protocols, disease management programs (DPMs), namely medical, CRT, and EECP, were performed in three study groups: group A; medical therapy (n=37), group B; EECP (n=16), and group C; CRT (n=27). Changes in New York Heart Association (NYHA) functional class and echocardiographic indexes were evaluated in the three groups. Results- There was no significant change in EF, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and E/Eʹ ratio after medical therapy. There was, however, a significant improvement in NYHA function class (P <0.001). EECP significantly improved EF (P<0.05) and E/Eʹ ratio (P<0.001). There was also a significant reduction in LVESV (P<0.05) with improvement in NYHA functional class and rehospitalization (P<0.001). CRT significantly reduced LVESV, LVEDV (P<0.05), E/Eʹ ratio (P<0.001), and EF (P<0.001).There was improvement in NYHA functional class and rehospitalization as well (P<0.001). Conclusion- Our findings suggest that disease management programs or guideline-based treatments reduce first hospitalization and rehospitalization rates in patients with heart failure and improve NYHA functional class and the echocardiographic findings of LVESV, LVEDV, LVEF, and E/Eʹ ratio. In the hope of improving HF outcomes, disease management programs (medical care, EFCP, CRT-D implantation, etc.) have been developed to standardize and optimize HF treatment, focusing on disease education for the patient and continuing support after hospital discharge (Iranian Heart Journal 2008; 9 (3):25 -36).