Study questions practice of routine fasting before cardiac catheterization
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Key takeaways:
- The CALORI study calls into question the practice of fasting before cardiac catheterization.
- Patients not required to fast reported higher overall satisfaction with no procedure-related adverse events.
Patients not required to fast before cardiac catheterization reported higher overall postprocedural satisfaction with no periprocedural adverse events, a speaker reported.
The results of the CALORI trial to evaluate the necessity of fasting before cardiac catheterization were presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
“Routine fasting prior to cardiac catheterization is something that we routinely do, and it’s been done for quite a long time as standard of care, but ... patients oftentimes are unhappy with this practice, especially if there is prolonged fast for cases later in the day,” Brian Mitchell, MD, MPH, interventional cardiology fellow at Virginia Commonwealth University Health Pauley Heart Center, said during a press conference. “There is limited evidence to support continued preprocedural fasting, especially in the cardiac catheterization space. Moreso, prolonged fasting, which is still prevalent, has been correlated with increased risk of harm to patients.
“The incidence of periprocedural aspiration, the need for emergent intubation or conversion of PCI to emergency CABG is exceedingly low,” Mitchell said. “Indiscriminate prolonged fasting requirements remain widely utilized, despite [American Heart Association] and [American Stroke Association] society guidelines that allow less restrictive regimens for our patients.”
To diagnose CVD, more than 1 million cardiac catheterizations are performed in the U.S. every year, according to the presentation.
Mitchell and colleagues conducted the present single-center, randomized trial, enrolling 198 inpatients undergoing elective or urgent catheterization (65% men; 42% Black). Procedures included coronary angiography, left heart catheterization, right heart catheterization and/or PCI with moderate conscious sedation.
Participants were randomly assigned to fasting after midnight or unrestricted eating before cardiac catheterization.
The primary endpoint was preprocedural patient satisfaction regarding hunger, fatigue, anxiety and nausea (each on a scale of 0-5), with five being the most extreme feeling. Secondary endpoints included postprocedural satisfaction and periprocedural adverse events.
The average time from last food intake was 970 minutes in the fasting group and 148 minutes in the nonfasting group (P < .001). There were no other significant differences in procedural characteristics between the two groups.
The summed patient-reported scores for preprocedural levels of hunger and fatigue were significantly lower in the nonfasting compared with the fasting group (2.4 vs. 6; P < .001). Individually, levels of preprocedural hunger (P < .001), fatigue (P < .001) and nausea (P = .006) were lower in the nonfasting group, but not anxiety, which was similar compared with the fasting group (P = .14)
One patient in each group experienced periprocedural emesis (P = 1), and there were no instances of aspiration or need for intubation in either group, according to the presentation.
There was also no significant differences in preprocedural and postprocedural renal function or blood glucose in either group.
Overall postprocedural patient satisfaction was higher in the nonfasting group compared with the fasting group (P < .001)
“This liberal nonfasting strategy improved both patient well-being and satisfaction, and although we weren’t technically powered to detect these rare adverse events like aspiration, it didn’t increase risk in this population. Multiple other studies in surgery and several small studies in coronary angiography have shown that [aspiration] is very uncommon,” Mitchell said during the press conference. “These findings, together with other studies, suggest that you should be a little more selective with the patients we choose for fasting.”
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Mitchell BK, et al. Featured clinical research part 1. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 2-4, 2024; Long Beach, Calif.
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