SCOFF: To fast or not to fast, that’s the question

No fasting led to better health outcomes and patient satisfaction than fasting in a population of patients who were undergoing cardiac catheterisation procedures, inciting the debate on whether fasting should be maintained before elective procedures requiring general/regional anaesthesia or procedural sedation and analgesia.

The pragmatic SCOFF trial randomised 716 participants scheduled for cardiac catheterisation procedures 1:1 to fasting or no fasting before their procedure. The participants were stratified for procedure site and procedure type (i.e. coronary or device intervention). In the fasting arm, participants fasted solid foods for 6 hours and clear liquids for 2 hours. The primary endpoint was a composite of aspiration pneumonia, hypotension, hyperglycaemia, and hypoglycaemia. Dr David Ferreira (John Hunter Hospital, Australia) presented the results [1].

With primary endpoint event rates of 19.1% in the fasting arm and 12.0% in the no-fasting arm, non-inferiority of no fasting to fasting was met. “No fasting was even superior to fasting,” added Dr Ferreira. The effect appeared to be spread across the various components of the primary outcome, except for aspiration pneumonia, of which no cases were reported in either arm (see Table). Patient Satisfaction Scores were also in favour of the no fasting arm (mean 11 vs 15; Bayes factor >100). “However, performance bias is likely to have influenced the outcomes of this measure,” commented Dr Ferreira.

Table: Primary composite outcome breakdown [1]



“No fasting was non-inferior and superior to fasting prior to coronary catheterisation and cardiac implantable device-related procedures for the primary composite outcome of aspiration pneumonia, hypotension, hyperglycaemia, and hypoglycaemia,” concluded Dr Ferreira.

1. 
   
   1. Ferreira D, et al. Safety and care of no fasting prior to catheterisation laboratory procedures: a non-inferiority randomised control trial (SCOFF trial): fasting versus no fasting prior to cardiac catheterisation procedures. HOTLINE 8, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024