Journal of the American College of Cardiology (JACC)2024 AHA/ACC Perioperative CV Management Guideline: Key Points

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The 2024 AHA/ACC Perioperative Cardiovascular Management Guideline for noncardiac surgery introduces significant updates to the 2014 version. This comprehensive guideline emphasizes a stepwise, patient-centered approach to perioperative cardiovascular assessment and management. It provides specific recommendations on risk stratification, preoperative testing, medication management, and postoperative care, aiming to improve patient outcomes and streamline clinical decision-making.

Key Points:

• The guideline recommends using validated risk-prediction tools like the Revised Cardiac Risk Index (RCRI) or National Surgical Quality Improvement Program (NSQIP) calculators for patients with known cardiovascular disease, risk factors, or concerning symptoms.
• Preoperative stress testing is now recommended only for highly selected patients, discouraged for low-risk patients or those undergoing low-risk procedures.
• Sodium-glucose cotransporter-2 inhibitors should be discontinued 3-4 days before planned surgery to reduce the risk of perioperative metabolic acidosis.
• For most patients on therapeutic anticoagulation, withholding direct oral anticoagulants or warfarin is appropriate, with bridging therapy reserved for high thrombotic risk cases.
• The guideline addresses perioperative atrial fibrillation management, emphasizing the importance of treating medical triggers and considering postoperative anticoagulation.
• Myocardial injury after noncardiac surgery (MINS) is recognized as a significant predictor of 30-day postoperative mortality, warranting outpatient cardiovascular follow-up.
• A team-based, patient-centered approach is emphasized, particularly for patients with complex or unstable cardiovascular disease.

HCN Medical Memo
The 2024 AHA/ACC Perioperative Cardiovascular Management Guideline offers a more tailored approach to patient care, emphasizing risk stratification and judicious use of preoperative testing. Physicians should familiarize themselves with these updates to optimize perioperative management and improve patient outcomes.

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