2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Individualizing Care in Patients With Associated Conditions and Comorbidities-The ACC and AHA recognize the complexity of managing patients with multiple conditions, compared with managing patients with a single disease, and the challenge is compounded when CPGs for evaluation or treatment of several coexisting illnesses are discordant or interacting.7 CPGs attempt to define practices that meet the needs of patients in most, but not all, circumstances and do not replace clinical judgment.Clinical Implementation-Management in accordance with CPG recommendations is effective only when followed; therefore, to enhance the patient's commitment to treatment and compliance with lifestyle adjustment, clinicians should engage the patient to participate in selecting interventions on the basis of the patient's individual values and preferences, taking associated conditions and comorbidities into consideration (eg, shared decision making).Consequently, there are circumstances in which deviations from these CPGs are appropriate.The recommendations in this CPG are the official policy of the ACC and AHA until they are superseded by a published addendum, focused update, or revised full-text CPG.