Do patients Need to Fast Prior to Coronary Interventions?

Dr Tahir Hamid MRCP (UK), FESC Department of Cardiology, Royal Albert Edward Infirmary NHS Trust,  Wigan, UKMedicalResearch.com Interview with:
Dr Tahir Hamid MRCP (UK), FESC
Department of Cardiology, Royal Albert Edward Infirmary
NHS Trust,  Wigan, UK


MedicalResearch.com: What are the main findings of the study?

Dr. Hamid: Traditionally patients undergoing diagnostic and interventional coronary artery procedures are kept Nil-by-mouth, but until yet there exists neither evidence nor clear guidance about the benefits of this practice in such patients. In our study performed at two National Health Services (NHS) institutes, we demonstrated in our 1916 patients, that such procedures could be undertaken without the need for being 4-6 hours fasting. None of our patients had major complications leading to pulmonary aspiration or emergency cardiac surgery.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Hamid:  Our study demonstrates that although there are coronary interventions related risks but emergency intubations leading to pulmonary aspiration was not common to our surprise.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Hamid:  This study is a prime example of quality improvement in providing safe and effective services to the patients. Our study is the starting point for global discussion to the traditional strict rules of pre-procedural fasting. As from our on-call cardiology commitments, we know that patients coming for Primary Percutaneous coronary interventions following acute myocardial infarction are not starved in the community and still they do well.

We recommend that based on the local guidance, clinician should start thinking of relaxing such strict rules of nil-per-mouth, which will have impact on health economics, patient satisfaction, less risk of missing medications, less overnight admissions for pre-hydrations and similarly less possibility of renal impairment.

Similarly, we demonstrated these results could well be applicable to physicians who are radial or femoral operators.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Hamid:  This is a retrospective study with no randomization or control arm. We recommend a randomised control study. We would suggest relaxing the stringent rules of pre-procedural fasting should be relaxed in low risk coronary interventions but this should be based on the local guidelines.

Citation:

Pre-procedural fasting for coronary interventions: is it time to change practice

 

Citation: Pre-procedural fasting for coronary interventions: is it time to change practice?

Tahir Hamid, Qaiser Aleem, Yeecheng Lau, Ravi Singh, John McDonald, Sanjay Sastry, Sanjay Arya, Anthony Bainbridge, Telal Mudawi, Kanarath Balachandran

Heart heartjnl-2013-305289Published Online First: 12 February 2014 doi:10.1136/heartjnl-2013-305289