For Cardiologists
A practical reference for referring cardiologists, interventional cardiologists, cardiac surgeons and general practitioners considering EECP for selected patients.
EECP is an adjunctive, non-invasive therapy intended to complement — not replace — guideline-directed medical therapy, cardiac rehabilitation, PCI, CABG or specialist cardiology care. The treating cardiologist retains responsibility for the patient's overall cardiac management, including all pharmacological decisions.
When to consider referral
EECP is most commonly considered where patients remain symptomatic despite optimal medical therapy and further revascularisation is not indicated, not feasible, or carries unfavourable risk.
Common referral profiles include:
- Refractory angina or chronic stable angina (typically CCS II–IV) despite optimal medical therapy
- Diffuse or complex coronary artery disease not amenable to PCI or CABG
- Persistent angina or ischaemic symptoms following PCI or CABG
- Reduced exercise tolerance attributable to ischaemia, including patients unable to progress through cardiac rehabilitation
- Suspected or confirmed microvascular angina / INOCA with ongoing symptom burden
- Limited anti-anginal options due to medication intolerance, hypotension or other clinical constraints
- Selected heart failure patients with reduced functional capacity, where clinically appropriate
Each referral is assessed individually in the context of the patient's overall cardiology management plan, current symptoms, investigations, comorbidities and safety considerations.
Referral workflow
Submit referral
Use the secure referral form, or email a referral letter to reception@vasoflo.com.au.
Acknowledgement
The clinic acknowledges receipt of the referral.
Clinical screening
Indication, contraindications and safety criteria are reviewed. The referring doctor is contacted if additional information is required.
Patient assessment
The patient is contacted to arrange an in-clinic assessment and consent discussion.
Treatment scheduling
If suitable, the patient is scheduled for the EECP course and the referring doctor is notified at commencement.
Communication with the treating doctor
Vasoflo communicates with the treating doctor at three points as a minimum: acknowledgement of referral, commencement of treatment, and at the end of treatment. Interim contact is made for any clinical concern arising during the treatment course.
Vasoflo does not initiate or alter cardiac medications. Any suggested medication changes are referred back to the treating cardiologist or GP.
Treatment schedule
A standard course is typically 40 one-hour sessions over approximately eight weeks, delivered once daily on weekdays. Twice-daily treatment may be considered in selected cases where clinically appropriate and tolerated. The schedule may be individualised based on clinical assessment and treatment objectives.
Treatment is delivered in an outpatient setting and does not require anaesthesia, incision or intravenous access. Patients are monitored with continuous ECG and finger plethysmography during treatment, with blood pressure assessed before and after each session.
Contraindications and precautions
Assessment of contraindications remains the responsibility of the treating or referring doctor. Vasoflo reviews referral information to confirm relevant safety considerations have been addressed before treatment commences, and contacts the referring doctor for clarification where any concerns or uncertainties are identified.
| Category | Examples |
|---|---|
| Acute coronary syndromes | Unstable angina, recent acute coronary syndrome or recent myocardial infarction. |
| Heart failure | Acute or decompensated heart failure, uncontrolled volume overload, or patients at high risk from increased venous return. |
| Valvular disease | Clinically significant valvular disease, particularly moderate-to-severe aortic regurgitation, severe aortic stenosis or other valve disease where diastolic augmentation or increased venous return may be poorly tolerated. |
| Rhythm / device triggering | Uncontrolled arrhythmias, heart rates outside a range suitable for EECP triggering, or pacemaker/device settings that interfere with inflation and deflation timing. |
| Vascular / thromboembolic | Severe peripheral arterial disease, severe lower-limb vaso-occlusive disease, active or recent DVT, thrombophlebitis, pulmonary embolism, clinically significant aortic aneurysm, or vasculitis affecting the extremities. |
| Haematological / bleeding risk | Active bleeding, significant bleeding disorder, coagulopathy, or anticoagulation outside the treating doctor's acceptable therapeutic range. |
| Blood pressure | Severe uncontrolled hypertension, commonly referenced as ≥180 mmHg systolic or ≥110 mmHg diastolic. |
| Respiratory | Severe chronic lung disease or pulmonary hypertension where increased venous return or treatment positioning may be poorly tolerated. |
| Recent procedures / trauma | Recent major surgery, recent cardiac catheterisation or femoral arterial puncture, recent lower-limb surgery, trauma or fracture. |
| Local cuff application | Burns, open wounds, active infection, significant skin breakdown or other conditions affecting safe cuff placement. |
| Other | Pregnancy or any other condition the treating/referring doctor considers relevant to EECP suitability. |
Clinical evidence
The clinical evidence for EECP is strongest in stable patients with chronic or refractory angina who remain symptomatic despite guideline-directed medical therapy and who have limited or unsuitable revascularisation options.
The MUST-EECP trial, a multicentre, randomised, sham-controlled study, demonstrated that active EECP significantly prolonged time to ≥1 mm ST-segment depression and reduced angina episode frequency compared with sham treatment, in patients with angina, documented coronary artery disease and objective exercise-induced ischaemia.
The International EECP Patient Registry and subsequent observational studies have reported reductions in CCS angina class, improved functional status and improved quality-of-life measures following a completed course of EECP, including in patients with prior PCI or CABG and those unsuitable for further revascularisation.
The ACC/AHA focused update for stable ischaemic heart disease states that EECP may be considered for relief of refractory angina in patients with stable ischaemic heart disease.
As with many therapies used in refractory angina populations, the evidence base includes both randomised and non-randomised data. Published outcomes should be interpreted in the context of patient selection, baseline symptom burden, comorbidities and study design.
See evidence summary and referencesFAQs for specialists
Is EECP suitable for patients post-CABG or post-PCI with persistent symptoms?
Yes, where the patient remains symptomatic despite optimal medical therapy. Each referral is assessed individually.
How is rhythm management handled in patients with arrhythmia?
Reliable ECG triggering is required for safe and effective EECP. Patients with significant uncontrolled arrhythmia are not suitable until rhythm is stabilised. Patients with controlled atrial fibrillation are assessed on a case-by-case basis.
Can patients continue cardiac rehabilitation during an EECP course?
Yes — EECP is often used alongside cardiac rehabilitation, and may help patients who have been unable to progress due to symptom burden.