Why is this study important? 

Routine pre-procedural fasting before cardiac catheterization remains the standard of care despite a lack of robust evidence to support this practice. The study investigated the impact of a liberal non-fasting strategy versus a standardized nil per os (NPO) regimen before cardiac catheterization. 

What question was this study supposed to answer? 

Adult inpatients undergoing elective or urgent cardiac catheterization were randomized (1:1 ratio) to either NPO past midnight or ad libitum intake of liquids and solids (without dietary constraints) immediately before the procedure. Only patients at high risk of aspiration or undergoing complex interventions were excluded. The primary endpoint was pre-procedural patient-reported satisfaction scores (scaled 0-5, 0 signifying absence of variable and five the most extreme form) for variables including hunger, fatigue, anxiety, and nausea. A composite summed well-being score combined hunger and fatigue. Other endpoints were post-procedural satisfaction and peri-procedural adverse events, including emesis, aspiration, or intubation. 

What did the study show? 

A total of 198 patients were included in the final analysis. There were no differences in baseline characteristics. There were no significant differences in adverse events between the groups. Post-procedural satisfaction scores were significantly better in the non-fasting versus NPO group (0.3 ± 0.7 vs. 1.0 ± 1.3, p<0.001). 

A liberal non-fasting strategy before cardiac catheterization significantly improves patient well-being and satisfaction without compromising safety. Few studies have prospectively explored this strategy in such a diverse patient population and with such liberal non-fasting allowances, making it the most comprehensive and generalizable study on this topic to date.