Cardiologist decision-making about pre-procedural fasting.

Abstract

INTRODUCTION AND BACKGROUND: Patients undergoing elective cardiology procedures may be at risk of preventable harm related to lengthy pre-procedural fasting. This qualitative study explored cardiologists' current practice choices and views towards pre-procedural fasting. AIMS: This study was undertaken to explore how cardiologists make decisions about pre-procedural fasting and what factors they consider when making these clinical decisions. METHODS: Semi-structured, individual interviews took place with cardiologists at the study site, the interviews were digitally recorded and then transcribed for later analysis. A constant comparative approach was used to identify key themes emerging from the interviews. RESULTS AND KEY THEMES: Eight cardiologists were interviewed, who managed cardiology patients pre-and post procedure and performed interventional procedures in the Cardiac Catheterisation Laboratory (CCL), such as Coronary Angiogram (CA), Percutaneous Coronary Intervention (PCI), Permanent Pacemaker (PPM) and Implantable Cardioverter Defibrillator (ICD) implant devices as well as cardioversion, Aortic Arch Stenting (AAS) and Right Heart Catheterisation (RHC). The average fasting practices as reported by the study participants were approximately four to six hours fasting for solid intake and clear fluids combined. The key themes emerging from the interviews included: professional expertise and the challenges associated with managing complex patients undertaking prolonged procedures. Both the importance of managing the potential for aspiration in patients receiving sedation, and preventing the complications associated with prolonged fasting such as dehydration, Contrast Induced Nephrotoxicity (CIN) and hypoglyaemia in patients with diabetes was discussed. DISCUSSION AND CONCLUSION: Cardiologists interviewed had strategies in place in their clinical practice to balance the potential side effects of prolonged fasting, such as individual patient assessment and widespread use of Intravenous (IV) fluid hydration during the cardiology procedures. The major contribution to knowledge of this study includes a better understanding of cardiologists' decision-making about pre-procedural fasting practices and also their preferences as far as future research goes.