Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Guideline for the Perioperative Cardiovascular Management of Adult Patients Undergoing Noncardiac Surgery
TAKE-HOME MESSAGE
- The 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline provides updated recommendations for the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. The recommendations include evidence-based management strategies such as pharmacological treatments, perioperative monitoring, and device use for cardiovascular disease and its associated medical conditions.
- This 2024 guideline supersedes the 2014 version and synthesizes the latest evidence to optimize patient care in noncardiac surgical settings.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIM
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.
Additional Info
Disclosure statements are available on the authors' profiles:
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
Circulation 2024 Sep 24;[EPub Ahead of Print], A Thompson, KE Fleischmann, NR Smilowitz, L de Las Fuentes, D Mukherjee, NR Aggarwal, FS Ahmad, RB Allen, SE Altin, A Auerbach, JS Berger, B Chow, HA Dakik, EL Eisenstein, M Gerhard-Herman, K Ghadimi, B Kachulis, J Leclerc, CS Lee, TE Macaulay, G Mates, GJ Merli, P Parwani, JE Poole, MW Rich, K Ruetzler, SC Stain, B Sweitzer, AW Talbot, S Vallabhajosyula, J Whittle, KA Williams SrFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Perioperative Management for Patients Undergoing Non-Cardiac surgery
Our patients will often need to undergo non-cardiac surgery. What should we, clinicians, do to help them prepare for their surgery? This guideline goes through all the things we should consider for stable patients with upcoming surgery.
To start, there is a nice algorithm that summarizes all the main steps we have to consider. The first step is to use a risk calculator to assess the patient's risk. Low-risk patients can proceed to surgery without further workup. However, high-risk patients need to undergo cardiovascular evaluation. The algorithm goes through a series of questions that helps us identify patients who need electrocardiography, echocardiography, stress test, serum BNP/NT-proBNP and troponin levels, and even coronary computer tomography angiography. The algorithm is straightforward and you can clearly see what tests are needed for each patient.
There is also a section on specific conditions like hypertrophic cardiomyopathy or mitral stenosis. Here, you just look up the specific condition and there are clear recommendations on what needs to be done perioperatively. In addition, all the supporting evidence is nicely summarized for each recommendation.
Furthermore, there is a separate section on medications and what should be done with these medications. For example, what should clinicians do with antiplatelet or anticoagulant therapies? How long before the surgery should we withhold them? When should we restart them after surgery? When do we need to use heparin to bridge when withholding anticoagulants? The recommendations are clearly laid out, with all the supporting evidence nicely summarized for each recommendation.
I must admit that I was quite overwhelmed when I first saw this document. However, the authors have done a good job of compartmentalizing the information. We do not need to read the whole document to be able to use it. Instead, we can access the exact bit of information that is relevant to our patient. This way, this guideline is useful as we see patients on a daily basis. We can quickly figure out how we can help our patients prepare for their non-cardiac surgeries.