After evaluating new evidence published over the last two years on perioperative cardiovascular management of patients following noncardiac surgery, the ACC/AHA Joint Committee on Clinical Practice Guidelines has determined that the most recent perioperative guideline published in 2024 “remains valid and current.” Read the full guideline published in JACC.

The reaffirmed 2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery is up-to-date and “the recommendations, supportive text, figures, tables, and references are identical to those in the 2024 publication,” according to Writing Committee Chair Annemarie Thompson, MD, MBA, and Vice Chairs Kirsten E. Fleischmann, MD, MPH, FACC, and Nathaniel Rosso Smilowitz, MD, MS, FACC.

In an editorial comment accompanying the reaffirmed guideline, Mary Norine Walsh, MD, MACC, reinforces the key takeaways from the guideline, including its emphasis on what should not be done.

“In assessing risk, we are encouraged to consider the procedure, the timing (urgent, time-sensitive, or elective), the patient’s clinical status, the mode of anesthesia, and possible surgical modifications to the procedure that might mitigate risk,” she writes. “Stress testing and other preoperative evaluation is reserved for patients with poor or unknown functional capacity.”

She also highlights where there remains little data, including outcomes for procedures done in ambulatory surgical centers compared with hospitals, and timing of “cardiac clearance” in determining risk for surgery. As a result, she stresses the importance of both disseminating the current guideline to surgical colleagues, as well as including patients in the critical decisions about their care.

The reaffirmed guideline was developed in collaboration with and endorsed by the American College of Surgeons, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society for Vascular Medicine.