The American Heart Association (AHA) and American College of Cardiology (ACC) have jointly released a comprehensive new guideline for managing cardiovascular risk in patients undergoing noncardiac surgery, updating the previous version from 2014 with a decade of new evidence. Published simultaneously in the journals Circulation and JACC, the '2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery' addresses the evaluation and management of cardiovascular disease risk throughout the surgical process. With approximately 300 million noncardiac surgeries performed worldwide each year, the guideline aims to assist clinicians in optimizing care and minimizing cardiovascular complications.
Dr. Annemarie Thompson, chair of the guideline writing group and professor at Duke University Medical Center, emphasized the importance of the update, noting the wealth of new evidence about how best to evaluate and manage perioperative cardiovascular risk. The guideline represents a comprehensive review of the latest research to help inform clinicians who manage perioperative patients, with the ultimate goal of restoring health and minimizing cardiovascular complications. Key updates in the guideline include a revised perioperative algorithm to guide care decisions for patients with cardiovascular conditions and updated recommendations on blood pressure management with specific guidance for patients with conditions such as coronary artery disease, hypertrophic cardiomyopathy, and pulmonary hypertension.
The guideline provides more targeted recommendations for cardiac screening tests like stress testing and offers guidance on using emergency-focused cardiac ultrasound during surgery for patients with unexplained hemodynamic instability. It also includes recommendations for managing newer medications, including SGLT2 inhibitors for diabetes and GLP-1 agonists for diabetes and obesity, along with updated advice on managing blood thinners before and after surgery. The guideline addresses emerging issues such as myocardial injury after noncardiac surgery (MINS) and the management of atrial fibrillation that occurs during or after surgery, conditions associated with worse outcomes that require careful monitoring and follow-up.
Dr. Thompson highlighted the need for a multidisciplinary approach, noting that the U.S. population is getting older and living longer with chronic health conditions including chronic heart and vascular diseases. A multidisciplinary, team-based approach involving surgeons, primary care physicians, cardiologists, internal medicine doctors and other medical specialists is needed to optimize care for patients with cardiovascular conditions and risk factors throughout the surgical process. The guideline was developed in collaboration with and endorsed by several medical societies, including the American College of Surgeons, the American Society of Nuclear Cardiology, and the Heart Rhythm Society, representing a significant update in the field of perioperative cardiovascular care.
Healthcare professionals are encouraged to review the full guideline for detailed recommendations and to incorporate this evidence-based guidance into their clinical practice. The comprehensive nature of the update reflects the ongoing evolution of perioperative cardiovascular care and the importance of staying current with the latest evidence to provide optimal patient care for millions undergoing noncardiac surgery each year. The guideline aims to improve outcomes through standardized approaches to cardiovascular risk management across diverse patient populations and surgical settings.
