2024 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

2024/09/24 by Annemarie Thompson, Kirsten E. Fleischmann, Nathaniel R. Smilowitz +34 · 304 citations
Medicine · #Cardiac, Anesthesia and Surgical Outcomes #Emergency medicine #Enhanced Recovery After Surgery #Guideline #Hemodynamic Monitoring and Therapy #Intensive care medicine #Internal medicine #MEDLINE #Medicine #Pathology #Perioperative #Perioperative medicine #Surgery

paper · doi:10.1161/cir.0000000000001285

published in Circulation 150(19), e351-e442 (Lippincott Williams & Wilkins)

openalex publication_date 2024/09/24 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05

Abstract

AIM: The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS: A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.

Citations

• Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery
• A brief self-administered questionnaire to determine functional capacity (The Duke Activity Status Index)
• The Effects of Mild Perioperative Hypothermia on Blood Loss and Transfusion Requirement
• Myocardial Injury after Noncardiac Surgery
• Validity and reliability of the Edmonton Frail Scale
• Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery
• Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery
• Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery
• Perioperative Hyperglycemia Management
• Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death
• Prospective Comparison of Preoperative Predictive Performance Between 3 Leading Frailty Instruments
• Prehabilitation for the Frailty Syndrome: Improving Outcomes for Our Most Vulnerable Patients
• Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

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• Functional capacity, frailty and the future of peri‐operative risk stratification
• Prospective Evaluation of Association Between American College of Surgeons NSQIP Risk Estimates and Multidisciplinary Operability Decisions in Complex Surgical Patients
• Peri‐operative management of diabetes mellitus: a multidisciplinary consensus statement from the Association of Anaesthetists and the Joint British Diabetes Societies for Inpatient Care group
• The Critical Role of Perioperative Medicine in Improving 30-Day Outcomes
• Closing the peri‐operative heart failure gap: insights and imperatives from METREPAIR
• Metabolic reprogramming in cancer therapy-related cardiovascular toxicity: Mechanisms and intervention strategies
• UpToDate®
• Perioperative management of antihypertensive agents
• 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
• Association of preoperative blood biomarkers with postoperative major adverse cardiac events and mortality in major orthopaedic surgery: a systematic review and meta-analysis. [europepmc]
• Perioperative Risk: Short Review of Current Approach in Non Cardiac Surgery. [europepmc]
• Safety assessment of sodium zirconium cyclosilicate: A FAERS-based disproportionality analysis. [europepmc]
• Frailty and Cardiac Complications after Minor and Major Noncardiac Surgery in Older Adults. [europepmc]
• Cardiac Troponin as a Prognostic Indicator for Major Adverse Cardiac Events in Non-Cardiac Surgery: A Narrative Review. [europepmc]
• The association of triglyceride glucose index and postoperative outcome in patients with severe spontaneous intracerebral hemorrhage: a multiple-center cohort study. [europepmc]
• Perioperative Stroke: Mechanisms, Risk Stratification, and Management. [europepmc]
• Preoperative Cardiovascular Risk and Postoperative Outcomes by Renin-Angiotensin System Inhibitor Use: A Secondary Analysis of a Randomized Clinical Trial. [europepmc]
• Preoperative Diagnostic Assessment of Patients with Cardiovascular Risk Factors Undergoing Noncardiac Surgery: A 2025 Update. [europepmc]
• Perioperative antihypertensive medications and effects on functional decline and mortality in non-cardiac surgery. [europepmc]
• Withholding vs. continuing angiotensin-converting enzyme inhibitors or angiotensin receptor blockers before surgery: a systematic review and meta-analysis of randomized controlled trials. [europepmc]
• Right-Sizing Testing Before Elective Surgery for Patients With Low Risk. [europepmc]
• 2025 Delphi consensus on robotic ventral mesh rectopexy. [europepmc]
• Geriatric nutritional risk index predicts perioperative cardiovascular events in older patients with coronary artery disease undergoing non-cardiac surgery: a multicenter retrospective cohort study. [europepmc]
• Sodium-Glucose Cotransporter-2 Inhibitors in Diabetes and Beyond: Mechanisms, Pleiotropic Benefits, and Clinical Use-Reviewing Protective Effects Exceeding Glycemic Control. [europepmc]
• A New Era, New Risks: The Cardio-Oncology Perspective on Immunotherapy in Non-Small Cell Lung Cancer. [europepmc]
• Association between baseline BMI and in-hospital mortality in critically ill cardiac surgery patients: a retrospective cohort study. [europepmc]
• Comparative effects of remimazolam and propofol on hemodynamic stability during sedation for painless gastroscopy: a randomized clinical trial. [europepmc]
• From Bench to Bedside: New Frontiers in Understanding and Treating Postoperative Delirium. [europepmc]
• Machine learning-based cardiovascular risk calculator for non-cardiac surgery. [europepmc]
• Criteria to Assess the Predictive and Clinical Utility of Novel Models, Biomarkers, and Tools for Risk of Cardiovascular Disease: A Scientific Statement From the American Heart Association. [europepmc]
• Intraoperative Hypotension and Delayed Graft Function after Kidney Transplantation: A Retrospective Cohort Analysis. [europepmc]
• Management of Peptic Ulcer Disease in Patients Taking Antithrombotic Agents. [europepmc]
• Prognostic value of the Duke Activity Status Index for preoperative cardiac risk stratification: an international pooled cohort study. [europepmc]
• Inflammatory Stewardship-A Perspective for Active Management of Acute Inflammation. [europepmc]

Related

• 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary
• 2024 EACTS guidelines on perioperative medication in adult cardiac surgery: embracing precision medicine driven by strong evidence-based methodology
• 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
• 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
• Intraoperative Hypotension and Myocardial Infarction Development Among High-Risk Patients Undergoing Noncardiac Surgery: A Nested Case-Control Study