Cardiology’s New Pillar: Why ECP is No Longer an “Alternative” (2025 Year in Review)
The landscape of External Counterpulsation (ECP) underwent a significant transformation in 2025, evolving from a “last-resort” treatment for refractory angina into a front-line therapy for microvascular disease, cognitive health, and post-viral recovery.
Below is a 2025 year-in-review summary to the landmark research and news that defined the field this year.
1. The “Maintenance” Era: Validating Multi-Course EECP
For years, the standard treatment was a single 35-hour course. However, a landmark study published in the Journal of Cardiovascular Development and Disease (September 2025) has shifted the protocol toward “maintenance” therapy.
The Research: Researchers led by A.S. Lishuta conducted a randomized, placebo-controlled trial (the EXCEL study) following 120 patients over 36 months.
The Findings: Patients receiving two courses per year (70 hours total) showed significantly higher event-free survival and greater improvements in left ventricular ejection fraction () and levels compared to those receiving a single course.
Link: Cardiovascular Effects of Long-Term Treatment with EECP (JCDD, 2025)
2. Long COVID & Fatigue: The Largest Cohort Study
2025 solidified EECP as a leading non-pharmacological intervention for Long COVID, particularly for patients suffering from “brain fog,” dyspnea, and chronic fatigue.
The Research: A large observational cohort study () published in late 2024 with 2025 follow-up data demonstrated clinical breakthroughs.
The Findings: Participants saw a 19.8-point improvement in the Seattle Angina Questionnaire (SAQ) and a dramatic reduction in fatigue (PROMIS scores). Most notably, 18 out of 23 patients in a specific sub-analysis were able to return to work after treatment.
Link: Role of Enhanced External Counterpulsation in Long COVID (PMC/NIH)
3. Cognitive Health: The “Brain Flow” Breakthrough
Research from the University of Kansas Medical Center has pioneered the use of EECP for Mild Cognitive Impairment (MCI) and early-stage Alzheimer’s, treating the brain as a vascular organ.
The Research: Led by Dr. Patrick Moriarty and Dr. Jeffrey Burns, a 190-participant study compared “real” EECP to a “sham” treatment.
The Findings: The EECP group scored 4.5 points higher on the VADAS-cog scale (Vascular Dementia Assessment Scale) than the sham group. Patients with Type 2 diabetes saw the most profound benefits, with a 14.6-point improvement.
4. AI Integration: The “Queen of Hearts” & Triage
The integration of AI into cardiology reached a fever pitch at TCT 2025. While not exclusive to ECP, the “Queen of Hearts” AI algorithm has redefined how we identify candidates for vascular intervention.
The News: Published in JACC: Cardiovascular Interventions and presented at TCT 2025, this AI (developed by PMcardio) identifies Occlusion Myocardial Infarction (OMI) that standard ECGs miss.
The Impact: By detecting microvascular and “silent” blockages with 92% sensitivity, this AI acts as a primary screening tool for the “Third Option” (EECP) in patients who aren’t candidates for traditional stents.
Link: AI-Based ECG Analysis (Queen of Hearts) Improves Detection (ACC News)
5. Policy & Access: 2025 Medicare Updates
The 2025 Medicare Physician Fee Schedule (PFS) brought new “Advanced Primary Care” codes that have opened doors for ECP to be included in comprehensive chronic care management.
The Update: CMS finalized new G-codes for Advanced Primary Care Management (APCM), allowing for better integration of non-invasive therapies like ECP into the primary care workflow.