A multisociety panel led by the American Heart Association and American College of Cardiology, with the American College of Surgeons among the co-authoring bodies, has issued the 2026 guideline on perioperative cardiovascular management for adults having noncardiac surgery. It explicitly supersedes the 2014 guideline that has anchored preoperative cardiac assessment for over a decade.
The update consolidates newer evidence across the areas a surgeon relies on preoperatively: cardiovascular risk evaluation, pharmacological therapy around surgery, perioperative monitoring, and the management of cardiac devices and associated conditions. The headline for a surgical service is that the reference standard has moved.
The practical step is to align your preoperative pathway and your shared protocols with anaesthesia and cardiology to the 2026 document rather than the 2014 one. The specific threshold and drug recommendations sit in the full guideline and should be read there before updating local checklists.
- The 2026 guideline replaces the 2014 ACC/AHA perioperative guideline and should be treated as the new reference.
- It is a multisociety document; the American College of Surgeons is among the co-authoring organisations.
- It updates preoperative risk evaluation, perioperative drug therapy, monitoring and device management.
- Align local preoperative pathways and anaesthesia and cardiology protocols to the new version.
- Read the full guideline for specific thresholds before changing local checklists.
Why it matters
It is the first full update in over a decade to how cardiac risk is assessed and managed before noncardiac surgery, so established local pathways may now be out of date.
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