A multisociety panel led by the American Heart Association and American College of Cardiology has issued the 2026 guideline on perioperative cardiovascular management for adults having noncardiac surgery, explicitly superseding the 2014 guideline that has anchored preoperative cardiac assessment for over a decade.
The update consolidates newer evidence across the areas anaesthetists use at the preoperative visit: cardiovascular risk evaluation, perioperative drug therapy, monitoring, and the management of cardiac devices and associated conditions. The headline for a perioperative service is that the reference standard has changed.
The practical step is to align the preoperative pathway and shared protocols with surgery and cardiology to the 2026 document rather than the 2014 one. Specific threshold and medication recommendations sit in the full guideline and should be read there before revising local checklists.
- The 2026 guideline replaces the 2014 ACC/AHA perioperative guideline as the reference standard.
- It updates preoperative risk evaluation, perioperative drug therapy, monitoring and device management.
- Align preoperative pathways and shared surgical and cardiology protocols to the new version.
- Read the full guideline for specific thresholds before changing local checklists.
- It is a consensus guideline consolidating evidence, not a single new trial.
Why it matters
It is the first full update in over a decade to how cardiac risk is assessed before noncardiac surgery, so established preoperative pathways may now be out of date.
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