ACCF/ACA focused update for perioperative evaluation and management

The update incorporates the latest recommendations for beta blockers into the body of the guideline. Here are the important beta blocker recommendations:

Class I
1.Beta blockers should be continued in patients undergoing surgery who are receiving beta blockers for treatment of conditions with ACCF/AHA Class I guideline indications for the drugs. (Level of Evidence: C)

Class IIa
1.Beta blockers titrated to heart rate and blood pressure are probably recommended for patients undergoing vascular surgery who are at high cardiac risk owing to coronary artery disease or the finding of cardiac ischemia on preoperative testing. (Level of Evidence: B)

2.Beta blockers titrated to heart rate and blood pressure are reasonable for patients in whom preoperative assessment for vascular surgery identifies high cardiac risk, as defined by the presence of more than 1 clinical risk factor. (Level of Evidence: C)

3.Beta blockers titrated to heart rate and blood pressure are reasonable for patients in whom preoperative assessment identifies coronary artery disease or high cardiac risk, as defined by the presence of more than 1 clinical risk factor, who are undergoing intermediate-risk surgery. (Level of Evidence: B)

It's worth mentioning that for statins, continue them if the patient was already on them (Class I) and consider starting them if the patient is undergoing vascular surgery (IIa). Alpha 2 agonists have been talked about for perioperative protection, but the guideline gives them no higher than a IIb recommendation (for periopertive hypertension control).