The reference most anaesthetists use for cardiac risk in noncardiac surgery, the 2014 ACC/AHA perioperative guideline, has been replaced. The 2026 multisociety guideline consolidates new evidence and explicitly supersedes the 2014 document.
The update spans the whole perioperative cardiovascular pathway: preoperative risk evaluation, pharmacological therapy, perioperative monitoring and the use of devices, for adults undergoing noncardiac surgery. Because it is a joint effort across many cardiovascular and perioperative societies, it is likely to become the common reference for preoperative clinics and anaesthetic preassessment.
The practical step is procedural rather than a single new number: review local preoperative pathways, risk-stratification tools and perioperative medication rules against the 2026 recommendations, and retire protocols still anchored to the 2014 version. Read the full guideline for the specific recommendations before changing a given practice.
- The 2026 multisociety guideline supersedes the 2014 ACC/AHA perioperative cardiovascular guideline.
- It covers preoperative risk evaluation, perioperative pharmacology, monitoring and devices for noncardiac surgery.
- It is a joint document across many cardiovascular and perioperative societies.
- Review local preassessment pathways and medication rules against the new version.
- Consult the full text for specific recommendations before changing a given practice.
Why it matters
The standard reference for perioperative cardiac risk has changed after twelve years, so preassessment protocols based on the old one may now be out of date.
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