To eat or not to eat: Is fasting still necessary before heart procedures?
Asking patients to fast before percutaneous coronary intervention (PCI) and other heart procedures may not be necessary, according to a new meta-analysis published in JSCAI.[1]
“Although the need for fasting prior to invasive cardiac procedures has been questioned for over a decade, current guidelines for both cardiology and anesthesia recommend a minimum of six hours fasting for solids and two hours for clear liquids prior to these procedures,” wrote first author Sebhat Erqou, MD, PhD, a cardiologist with the department of medicine at Mary Washington Hospital, and colleagues. “While the rationale for fasting has been to reduce the risk of vomiting and aspiration pneumonia that accompanies sedation, mounting observational data suggests that these are very rare complications after cardiac procedures in patients who do not receive general anesthetics.”
To learn more, Erqou et al. explored data from nearly 3,500 patients who participated in one of eight different randomized controlled trials (RCTs). More than 50% of patients fasted before undergoing treatment, and the remaining patients did not fast. The average fasting time was 845 minutes—or approximately 14 hours—and the procedures included PCI, right heart catheterizations and cardioverter-defibrillator implantation.
Overall, patients who did not fast were associated with significantly higher patient satisfaction scores. Lengths of stay for the two approaches were similar. In addition, the reported rates of nausea/vomiting, hypoglycemia, pneumonia and death were all similar.
The patients who fasted were associated with a slightly lower risk of contrast-induced nephropathy, the authors added, but the difference between groups was not statistically significant.
“The study confirmed the safety of nonfasted protocols in terms of feared procedural complications such as vomiting and aspiration pneumonia and their superiority in terms of hunger and patient satisfaction compared with fasting protocols,” the authors wrote. “While our meta-analysis focused on cardiac procedures that did not require general or monitored anesthesia care, one recent RCT looking at transaortic valve replacement or atrial fibrillation ablation reported similar results. These findings lend further evidence for reconsideration of current fasting guidelines prior to elective and urgent invasive cardiac procedures. An interdisciplinary review by cardiology and anesthesiology societies is warranted.”
Click here to read the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.