A new guideline released jointly by the American Heart Association and American College of Cardiology provides updated recommendations for managing cardiovascular risk in patients undergoing noncardiac surgery. Published simultaneously in the journals Circulation and JACC, the 2024 guideline reflects a decade of new evidence since the last update in 2014.
The comprehensive guideline addresses the evaluation and management of cardiovascular disease risk for patients scheduled for noncardiac surgery requiring general or regional anesthesia. It provides evidence-based recommendations for patient assessments, cardiovascular testing and screening, and management of cardiovascular conditions before, during and after surgery.
With approximately 300 million noncardiac surgeries performed worldwide each year, the guideline aims to assist clinicians in optimizing care and minimizing cardiovascular complications for surgical patients. It targets the many healthcare professionals involved in perioperative care, including surgeons, anesthesiologists, cardiologists, and primary care physicians.
Key updates in the 2024 guideline include recommendations on blood pressure management, specific guidance for patients with conditions like coronary artery disease and valvular heart disease, and considerations for newer diabetes and obesity medications. The guideline advises judicious use of preoperative cardiac stress testing and provides guidance on using emergency cardiac ultrasound during surgery for patients with unstable blood pressure.
Importantly, the guideline addresses emerging issues like myocardial injury after noncardiac surgery (MINS) and post-operative atrial fibrillation. It emphasizes the need for outpatient follow-up and risk factor modification for patients who develop these complications.
The guideline also provides updated recommendations on perioperative management of blood thinners and other cardiovascular medications. For instance, it advises discontinuing SGLT2 inhibitors 3-4 days before surgery to reduce ketoacidosis risk.
Dr. Annemarie Thompson, chair of the guideline writing committee, emphasized the importance of a multidisciplinary approach to perioperative cardiovascular care. As the U.S. population ages and more people live with chronic cardiovascular conditions, coordinated care among surgeons, cardiologists, anesthesiologists and other specialists is critical for optimizing surgical outcomes.
This comprehensive update has significant implications for clinical practice. By incorporating the latest evidence, it aims to improve cardiovascular risk assessment and management for the millions of patients undergoing noncardiac surgery each year. Healthcare providers across specialties will need to familiarize themselves with these recommendations to provide optimal perioperative care.
The guideline's emphasis on judicious use of preoperative testing and tailored management of cardiovascular medications may help reduce unnecessary interventions and complications. At the same time, its focus on emerging issues like MINS highlights areas needing further research and vigilance.
As surgical techniques and anesthetic practices continue to evolve, ongoing updates to perioperative cardiovascular care guidelines will remain crucial. This latest guideline provides an important framework for evidence-based management, but also underscores the need for continued research to address knowledge gaps and emerging challenges in this critical area of patient care.
