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September 30, 2026Circulation
2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Why the study?
Updated evidence and management strategies were needed to guide clinicians in perioperative cardiovascular evaluation and management for adult patients undergoing noncardiac surgery, superseding the 2014 guideline.
Population
Adult patients undergoing noncardiac surgery
Comparison
Updated guideline recommendations vs 2014 ACC/AHA guideline
Design
Comprehensive literature review and guideline update by joint committee
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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. Stress testing and other preoperative evaluation is reserved for patients with poor or unknown functional capacity.”
“An example of this would be a sedated gastroenterological procedure, perhaps even in an outpatient setting, that's considered a fairly low-risk procedure. If they have high-risk cardiovascular features, they are at increased risk for cardiovascular complications. With that situation, it's important that all clinicians—not just the anesthesiologist or the cardiologist, but also the proceduralist—know that there are patients going for what might be, in other patients, a fairly routine low-risk procedure but can be an elevated-risk procedure for a patient with preexisting cardiovascular disease.”
“Our role in this process is not to 'clear' patients for surgery, but to estimate the risks and benefits of surgery, guide medical decisions, and facilitate informed decision making between the surgeons, anesthesiologists, and—most importantly—the patient.”
Overview
Guides perioperative CV evaluation and management for noncardiac surgery; extends prior guidelines with synthesized 2022–2023 evidence.
Key Points
- Evidence-based recommendations establish updated cardiovascular management protocols for adult patients undergoing noncardiac surgery across clinical environments.
- Guideline literature search across MEDLINE and EMBASE from August 2022 to March 2023 synthesizes human evidence to support tailored pharmacological therapies.
- Highlights structured perioperative monitoring and medical devices to reduce complications, superseding earlier 2014 guidance for cardiovascular disease.
Structured PICO
P
Population
Adult patients undergoing noncardiac surgery requiring perioperative cardiovascular evaluation and management.
I
Intervention
Perioperative cardiovascular evaluation and management strategies, including pharmacological therapies, perioperative monitoring, and devices
The 2026 AHA/ACC joint committee guideline updates the 2014 recommendations for perioperative cardiovascular management in noncardiac surgery.
Cite This Study
Thompson et al. (2026) conducted a review in Perioperative cardiovascular management for noncardiac surgery. Perioperative cardiovascular management guidelines was evaluated. The 2026 AHA/ACC joint committee guideline provides updated evidence-based recommendations for the perioperative cardiovascular evaluation and management of adults undergoing noncardiac surgery.