Fasting Versus Non-Fasting Before Cardiac Catheterization: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Current guidelines recommend routine fasting before cardiac catheterization under conscious sedation. However, data supporting this practice have been limited.

AIMS: We aimed to compare the safety and patient well-being of a non-fasting strategy to standard fasting in patients who undergo heart catheterization procedures.

METHODS

We conducted a meta-analysis of randomized studies comparing fasting versus non-fasting before cardiac catheterization. We systematically reviewed PubMed, Embase, and Cochrane databases until October 2024. We incorporated unpublished subgroup data from the previously published SCOFF Trial, exclusively on patients who underwent catheterization procedures.

RESULTS

We included 7 RCTs comprising 3289 patients who underwent cardiac catheterization procedures. The pooled analysis demonstrated the non-inferiority of the non-fasting strategy, with no significant differences in the incidences of nausea/vomiting (RR 0.90; 95% CI 0.50-1.61; p = 0.72), hypoglycemia (RR 0.78; 95% CI 0.45-1.35, p = 0.38), acute kidney injury (RR 1.45; 95% CI 0.77-2.75, p = 0.251), and length of hospital stay (SMD 0.005, 95% CI -0.109 to 0.099, p = 0.92) compared to the fasting strategy. The non-fasting strategy was significantly associated with reduced rates of intraprocedural hypotension and showed a statistically significant improvement in overall patient satisfaction (SMD -0.749; 95% CI -1.26; -0.234, p = 0.004) when compared to the fasting strategy.

CONCLUSION

A non-fasting strategy before cardiac catheterization procedures is as safe as the standard fasting protocol and demonstrates a significant improvement of overall patient satisfaction. These findings support the consideration of non-fasting protocols as a patient-centered approach that maintains safety while enhancing the patient experience.