"I tell everybody," said Majer, 74, as his body rocked up and down to the rhythm of the inflating cuffs at a Cottman Avenue clinic last month.
Although time-consuming, EECP, or enhanced external counterpulsation, has been shown to be effective in relieving chest pain and to provide benefits similar to those of vigorous exercise, even for patients whose coronary artery disease makes such exercise impossible. It is noninvasive and moderate in cost: Medicare pays a little more than $5,000 for 35 hours. But the procedure has failed to catch on with cardiologists.
Some experts say specialists tend to favor aggressive intervention, such as stents or heart-bypass surgery. Others say too little is known about how EECP works and which patients benefit. Not all patients do, said Alfred Bove, the longtime chief of cardiology at Temple University Hospital and immediate past president of the American College of Cardiologists.
"There's a lot of patients that come back, shaking their head, and say, 'Look, they bounced me up and down for a couple of weeks - nothing happened,' " Bove said.
The Food and Drug Administration approved EECP for angina treatment in 1995. The procedure is intended for patients with coronary artery disease who are not candidates for bypass surgery or other invasive treatment, such as angioplasty or stenting.
Physician Debra Braverman opened her first EECP clinic in Center City in 2000, after Medicare approved the procedure for reimbursement. There was little awareness of EECP then among cardiologists, she said.
Braverman said that for patients like Majer who are not willing to accept an inactive lifestyle, she saw the technology as a quality-of-life saver.
"My goal was to have EECP be a household name by now," she said.
That hasn't happened.
Braverman's practice grew by 2004 to five offices in the Philadelphia area. When she sold it to Albert Einstein Healthcare Network three years later, she was running just the one on Cottman Avenue. Braverman, who published a book about the treatment in 2005, said she closed the others to fit Einstein's needs.
But the industry has been shrinking. Usage among Medicare patient dropped precipitously from 410,859 one-hour sessions in 2004 to 253,023 in 2009. Manufacturer Vasomedical Inc. has had years of operating losses, according to federal records.
EECP is "a very simple thing, which is one of the elegant and wonderful things about it," Braverman said.
But, she said, "there's definitely resistance."
Braverman said she thinks doctors are driven toward higher-cost remedies.
"The American medical establishment is very focused on high-tech," she said.
In its guidelines for managing chronic chest pain, the American College of Cardiologists says EECP could be tried for patients whose symptoms do not respond to medication or surgery. But it does not readily encourage the procedure.
Arthur Feldman, cardiologist and chairman of Thomas Jefferson University Hospital's Department of Medicine, said he was skeptical before he started studying EECP years ago at the University of Pittsburgh School of Medicine.
As he and others there saw patients improve with treatment, he said, "we just sort of became believers."
Feldman worked on several outcome studies. But, he said, it would take more research on how EECP works, who benefits and what role genetics play for it to become more widely accepted.
A small study in the October journal of Circulation made progress in answering some of those questions, Feldman said.
The study looked at EECP's effect on 28 people with coronary artery disease and chronic chest pain. It found that the treatment improves blood flow through arteries and increases a signal produced by the lining of blood vessels that causes the vessels to dilate.
"It is something doctors should pay attention to," Feldman said.
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