A Mixed Methods Study Exploring Patient Perspectives and Outcome Measures From Not Fasting Before Cardiac Catheterisation.

BACKGROUND & AIM: This study aimed to describe the patient experience and incidence of adverse events in unfasted patients undergoing coronary angiography and angioplasty. In addition, to identify any association between duration of fasting and adverse events. Historically, patients were fasted before elective cardiac catheterisation. Routine fasting was not evidence-based, and many centres, including our unit, have discontinued the practice. METHODS: Patients undergoing cardiac catheterisation at a large urban teaching hospital were invited to participate in a prospective observational cohort study documenting the duration of fasting and incidence of adverse events (n=508). Of these participants, 257 also completed a survey that captured perspectives and opinions regarding not fasting. RESULTS: The mean time since last fluid was 1.9±2.2 hours and for food was 3.9±3.7 hours. The most common adverse event was hypotension (10.0%). Rates of nausea (3.9%) and vomiting (0.6%) were low, and there were no episodes of aspiration. No associations were identified between the time since the last food or fluid and any adverse events. Thematic analysis of survey data yielded three themes: (1) in most, not fasting is preferable to fasting; (2) being able to eat and drink before the procedure positively affected well-being, and (3) one-fifth of the cohort expressed no preference between fasting and non-fasting. CONCLUSIONS: Not fasting before cardiac catheterisation is viewed favourably by patients. While this study provides additional evidence that not fasting is safe, event rates are low, and larger multicentre studies are needed for confirmation.

Is not fasting before cardiac catheterisation better than fasting? A systematic integrative literature review.

AIM: To synthesise international evidence about not fasting before cardiac catheterisation. METHODS: We used a systematic, integrative literature review and applied quality assessment criteria. RESULTS: Nine of 1,535 articles met the inclusion criteria. Critique and analysis of the literature revealed three themes: (1) Fasting before coronary angiography and angioplasty is associated with perceived risk management, not actual risk management. (2) Not fasting before coronary angiography and angioplasty is considered safe and beneficial for the patient when compared to the risks of fasting. (3) Current practice, evidence and guidelines are inconsistent. CONCLUSION: Ongoing concerns regarding not fasting before cardiac catheterisation are related to perceived risk, not actual risk. Indeed, this review indicates that not fasting may optimise patient experience. Further large-scale research is needed in this area to support policy and practice change to a patient-centric fasting protocol.