2024 Updated ACC/AHA Guideline for Perioperative Cardiovascular Management in Noncardiac Surgery

 ACC/AHA Perioperative Guideline For Noncardiac Surgery, published in September 2024, provides updated recommendations for perioperative cardiovascular (CV) management.

The guideline builds on the 2014 release, incorporating new scientific evidence on epidemiology, risk calculators, diagnostic testing, and perioperative management.

It includes dedicated sections on medical therapy, anesthetic considerations, and myocardial injury management.

A stepwise approach is emphasized for assessing perioperative cardiac risk and guiding surgical decisions.

Clinicians are advised to use targeted screening based on indications and avoid unnecessary stress testing.

Team-based care is highlighted for patients with complex anatomy or unstable CV conditions.

The guideline outlines hypertension management and recommendations for patients with specific conditions like coronary artery disease, atrial fibrillation, and obstructive sleep apnea.

Special populations, including patients undergoing transplantation or bariatric surgery, receive tailored recommendations.

It advises discontinuing SGLT2 inhibitors three to four days before surgery to prevent perioperative ketoacidosis, a potentially serious complication.

New insights into myocardial injury and its implications for patients are also discussed.

The guideline incorporates cost considerations, evidence gaps, and future research directions.

Endorsed by eight leading societies, it aims to restore health and reduce CV complications during noncardiac surgery.

Take-Home Points

1. Use a stepwise approach to perioperative cardiac assessment.
2. Prioritize team-based care for complex CV cases.
3. Tailor management for patients with specific conditions and special populations.
4. Discontinue SGLT2 inhibitors three to four days before surgery to prevent perioperative ketoacidosis.
5. Recognize myocardial injury after noncardiac surgery as a serious condition.
6. Utilize resources like ACC guideline hubs and interactive tools for optimal implementation.