Enhanced External Counterpulsation Improves Cognitive Function of Persons with Long COVID.

OBJECTIVE: To determine the effects of Enhanced External Counterpulsation (EECP) in patients with long COVID and objectively assessed cognitive impairment. DESIGN: A retrospective evaluation of long COVID patients referred for EECP, with cognitive sequela, and having completed an objective digital assessment before and after therapy. Patients had either cognitive impairment (CI) or no cognitive impairment (NCI) at baseline. We assessed changes in composite score using multi-factor ANOVA. Multiple linear and logistic regression analyses were conducted to evaluate several independent variables. RESULTS: 80 long COVID patients (38 CI vs 42 NCI) were included for analyses. All baseline characteristics were well matched. There was significant improvement in composite score post-EECP in those with objective cognitive impairment at baseline. There were no notable documented safety concerns. CONCLUSION: This is the first study showing that EECP led to significant improvement in cognitive functioning of long COVID patients with objectively defined cognitive impairment. Although a lack of a negative control group is a limitation of this study, EECP appears to be highly safe and effective with the potential for widespread application.

Enhanced External Counterpulsation for the Treatment of Angina With Nonobstructive Coronary Artery Disease.

Angina and nonobstructive coronary artery disease (ANOCA) is associated with poor outcomes and limited treatment options. Enhanced external counterpulsation (EECP) is a noninvasive treatment that involves applying external inflatable cuffs to the lower extremities to increase blood flow during diastole, followed by deflation during systole. Although EECP is approved for treatment in patients with refractory angina due to obstructive coronary artery disease, its effectiveness in treating patients with ANOCA with refractory angina is limited to small studies. We assessed the efficacy of EECP treatment in patients with ANOCA (defined as ≤50% stenosis in any major epicardial vessels) with refractory anginaby measuring changes in Canadian Cardiovascular Society (CCS) angina class, 6-minute walk test, Duke Activity Status Index (DASI), Seattle Angina Questionnaire 7 (SAQ7), and weekly anginal episodes pre-EECP and post-EECP treatment. A total of 101 patients with ANOCA with CCS class III/IV angina completed a full course of EECP treatment at 2 large EECP centers. In 101 patients with ANOCA the mean age (SD) of 60.6 (11.3) years and 62.4% of the cohort were women. We found significant improvements post-EECP treatment in CCS angina class (mean (SD) 3.4 (0.5) to 2.4 (2.9), p <0.001), 6-minute walk test (median 1200 (IQR 972 to 1411) to 1358 (1170 to 1600), p <0.001), DASI (mean (SD) 15.2 (11.6) to 31.5 (16.3), p <0.001), SAQ7 (mean (DS) 36.2 (24.7) to 31.5 (16.3), p <0.001), and weekly anginal episodes (mean (SD) 5.3 (3.5) to 2.4 (2.9), p <0.001). After EECP treatment, 71 patients (70.3%) had an improvement of ≥1 CCS angina class, including 33 (32.7%) patients improving by ≥2 CCS classes. In conclusion, in patients with ANOCA, EECP therapy reduces CCS angina class and improves exercise tolerance and capacity; and should be considered a part of optimal medical therapy.

Mask Mirroring: A Novel Approach to Healthcare Empathy in the COVID-19 Era.

The COVID-19 pandemic has brought forth substantial changes to societal norms and global health infrastructure, one of the most impactful being mask wearing. With varying attitudes toward mask usage in a post-pandemic environment, this paper introduces the concept of "mask mirroring" in healthcare settings. This strategy involves healthcare providers reciprocating the mask-wearing behavior of their patients, intending to respect patients' choices and alleviate their potential concerns and anxieties. It is hypothesized that mask mirroring could serve as a symbol of empathy and solidarity, enhancing the doctor-patient rapport and facilitating effective healthcare delivery. In addition, it could reduce the transmission of respiratory infections, fostering a safer healthcare environment. Importantly, mask mirroring addresses the power dynamics between healthcare providers and patients, allowing patients' preferences and comfort to be prioritized. The implementation of this concept requires clear communication about its purpose and symbolism, striking a balance between reassurance and respect for differing viewpoints. The ultimate aim of mask mirroring is to promote patient-centric care, reflecting our commitment to understanding and empathizing with patients' concerns in a world recovering from COVID-19.