The 2024 ACC cardiac clearance algorithm is not much different than 2014. The main difference is that it provides explicit "off-ramps" for clinicians to focus on issues requiring significant attention before proceeding with the remainder of the decision tree. These off-ramps were present in the 2014 cardiac evaluation, but were not explicitly built in to the official algorithm as they are now.
The main off-ramps are for severe and/or unstabilized conditions like heart failure, arrhythmias, and valvular disease, as they were in 2014.
Another refreshing off-ramp is the preliminary "step 0" (my term) regarding whether cardiac assessment is necessary at all.
There is another small difference with the introduction of BNP and hs-Trop testing as an option.
The cardiovascular risk factors that ACC enumerates are hypertension, smoking, hyperlipidemia, diabetes, female age > 65, male age > 55, obesity, family history premature CAD.
Yes, no kidding, the ACC says that if you really have a healthy patient, the patient can proceed to surgery!
The subsequent steps in this decision tree will be more familiar for those who know previous guidelines, starting with the question regarding urgency of surgery.
The very end of the 2007 algorithm has guidance I find useful, thus I'm preserving its availability.
