Meeting News

New study questions fasting before cardiac catheterization

Patients undergoing cardiac catheterization are generally instructed to follow nothing by mouth, or NPO, before the procedure. A single-center study reported at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions showed no significant difference in adverse events with standard fasting compared with unrestricted oral intake.

The CHOW NOW study randomly assigned 306 patients undergoing nonemergent cardiac catheterization to standard fasting and 293 to unrestricted oral intake before the procedure.

The primary outcome — a composite of aspiration pneumonia, periprocedural hypotension, periprocedural hypoglycemia or hyperglycemia, nausea and vomiting, and contrast-induced nephropathy — occurred in 11.3% of patients assigned unrestricted oral intake vs. 9.8% assigned standard fasting (P = .65). Nonfasting was noninferior to the standard fasting strategy for the primary outcome (noninferiority margin threshold, 0.059), Abhishek Mishra, MD, cardiologist at Vidant Heart and Vascular Institute-North Carolina, said during a press conference.

“In this randomized controlled trial, we found that there was no significant difference in the rate of overall adverse events with an approach of unrestricted oral intake prior to cardiac catheterization compared to standard fasting practice,” Mishra said.

Other findings demonstrated no significant differences in:

  • in-hospital morality: standard fasting group, 0.3%; nonfasting group, 0.7%; P = .616;
  • patient satisfaction: mean score, 4.4 in standard fasting group vs. 4.5 in nonfasting group (P = .257); and
  • total cost of hospitalization: mean cost, $8,466 in standard fasting group vs. $6,960 in nonfasting group (P = .654).

When the researchers looked at the data between inpatients and outpatients, the “nonfasting strategy was associated with better patient satisfaction and lower cost of care especially for hospitalized patients,” Mishra said. Discussing this finding during the press conference, Mishra noted, for example, that a hospitalized patient could be made NPO after midnight but could ultimately fast for a longer period due to delays or other urgent cases before undergoing the procedure, which can lead to patient frustration.

The CHOW NOW study was performed at the Guthrie Clinic/Robert Packer Hospital in Sayre, Pennsylvania. The patient population included inpatients (n = 294) and outpatients (n = 305) undergoing nonemergent coronary angiogram, left and right heart catheterization or PCI.

The standard fasting group was instructed to be NPO after midnight, irrespective of the time of the procedure, but could have clear liquids up to 2 hours before the procedure. The nonfasting group had no restrictions on oral intake.

Timothy D. Henry

“I do think patients don’t like being NPO,” Timothy D. Henry, MD, FACC, MSCAI, vice president of SCAI and medical director of the Carl and Edyth Lindner Center for Research and Education at The Christ Hospital in Cincinnati, said during a discussion of the study.

Henry questioned whether the results of this modest-sized study will change practice, however. “Because most of this is not dictated by us as interventional cardiologists; it’s dictated by hospital policies or anesthesia people. But I think all of us, in 2020, when we do caths, we almost never see patients who have nausea or vomiting.”

Kirk N. Garratt

Kirk N. Garratt, MD, MSc, MSCAI, press conference moderator, the John H. Ammon Chair of Cardiology and director of the Center for Heart and Vascular Health at Christiana Care in Delaware and past president of SCAI, said “there’s opportunity in this type of work,” and suggested further evaluation to the impact of fasting in the diabetic population, in particular. – by Katie Kalvaitis

Reference:

Mishra A, et al. Featured Clinical Research. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).

Disclosures: Mishra and Henry report no relevant financial disclosures. Garratt reports financial relationships with Abbott, Jarvik Heart and LifeCuff Technologies.

Patients undergoing cardiac catheterization are generally instructed to follow nothing by mouth, or NPO, before the procedure. A single-center study reported at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions showed no significant difference in adverse events with standard fasting compared with unrestricted oral intake.

The CHOW NOW study randomly assigned 306 patients undergoing nonemergent cardiac catheterization to standard fasting and 293 to unrestricted oral intake before the procedure.

The primary outcome — a composite of aspiration pneumonia, periprocedural hypotension, periprocedural hypoglycemia or hyperglycemia, nausea and vomiting, and contrast-induced nephropathy — occurred in 11.3% of patients assigned unrestricted oral intake vs. 9.8% assigned standard fasting (P = .65). Nonfasting was noninferior to the standard fasting strategy for the primary outcome (noninferiority margin threshold, 0.059), Abhishek Mishra, MD, cardiologist at Vidant Heart and Vascular Institute-North Carolina, said during a press conference.

“In this randomized controlled trial, we found that there was no significant difference in the rate of overall adverse events with an approach of unrestricted oral intake prior to cardiac catheterization compared to standard fasting practice,” Mishra said.

Other findings demonstrated no significant differences in:

  • in-hospital morality: standard fasting group, 0.3%; nonfasting group, 0.7%; P = .616;
  • patient satisfaction: mean score, 4.4 in standard fasting group vs. 4.5 in nonfasting group (P = .257); and
  • total cost of hospitalization: mean cost, $8,466 in standard fasting group vs. $6,960 in nonfasting group (P = .654).

When the researchers looked at the data between inpatients and outpatients, the “nonfasting strategy was associated with better patient satisfaction and lower cost of care especially for hospitalized patients,” Mishra said. Discussing this finding during the press conference, Mishra noted, for example, that a hospitalized patient could be made NPO after midnight but could ultimately fast for a longer period due to delays or other urgent cases before undergoing the procedure, which can lead to patient frustration.

The CHOW NOW study was performed at the Guthrie Clinic/Robert Packer Hospital in Sayre, Pennsylvania. The patient population included inpatients (n = 294) and outpatients (n = 305) undergoing nonemergent coronary angiogram, left and right heart catheterization or PCI.

The standard fasting group was instructed to be NPO after midnight, irrespective of the time of the procedure, but could have clear liquids up to 2 hours before the procedure. The nonfasting group had no restrictions on oral intake.

Timothy D. Henry

“I do think patients don’t like being NPO,” Timothy D. Henry, MD, FACC, MSCAI, vice president of SCAI and medical director of the Carl and Edyth Lindner Center for Research and Education at The Christ Hospital in Cincinnati, said during a discussion of the study.

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Henry questioned whether the results of this modest-sized study will change practice, however. “Because most of this is not dictated by us as interventional cardiologists; it’s dictated by hospital policies or anesthesia people. But I think all of us, in 2020, when we do caths, we almost never see patients who have nausea or vomiting.”

Kirk N. Garratt

Kirk N. Garratt, MD, MSc, MSCAI, press conference moderator, the John H. Ammon Chair of Cardiology and director of the Center for Heart and Vascular Health at Christiana Care in Delaware and past president of SCAI, said “there’s opportunity in this type of work,” and suggested further evaluation to the impact of fasting in the diabetic population, in particular. – by Katie Kalvaitis

Reference:

Mishra A, et al. Featured Clinical Research. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).

Disclosures: Mishra and Henry report no relevant financial disclosures. Garratt reports financial relationships with Abbott, Jarvik Heart and LifeCuff Technologies.

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