📰 What's New

The first guideline of its kind, published in JACC on June 9, 2026. It retires and replaces the 2013 AHA/ACC/TOS obesity guideline. The central argument: obesity, type 2 diabetes, chronic kidney disease and cardiovascular disease are not four separate problems managed in four separate clinics, they are one interconnected syndrome, and staging it changes what you screen for and when.
CKM stages 0 to 4 NEW: Stage 0 normal weight, glucose, BP, lipids and kidney function with no CVD. Stage 1 excess or dysfunctional adipose tissue, prediabetes. Stage 2 metabolic risk factors (hypertriglyceridemia, hypertension, metabolic syndrome, T2D) or moderate-to-high-risk CKD. Stage 3 subclinical CVD with CKM risk factors, or high predicted 10-year CVD risk (≥ 20%). Stage 4 clinical CVD (coronary disease, heart failure, stroke, PAD, atrial fibrillation) with CKM risk factors.
Screening cadence is set by stage, which is the practical change for clinic: anthropometrics and blood pressure annually in everyone; lipids, glucose and eGFR every 5 years in Stage 0, every 2 to 3 years in Stage 1, annually in Stage 2; and urine albumin-to-creatinine ratio annually from Stage 2 onward.
Risk tool: the PREVENT equations, the same family adopted by the 2026 dyslipidemia guideline, so one calculator now serves both.
Drug therapy by problem: GLP-1 receptor agonists (semaglutide, tirzepatide) for obesity, with bariatric surgery considered in Stages 1 to 3. SGLT2 inhibitors as foundational therapy in T2D. Semaglutide specifically for kidney protection when albuminuria is present. RAS inhibitors for everyone with albuminuria, and a nonsteroidal mineralocorticoid receptor antagonist (finerenone) for persistent albuminuria despite that.
Honest caveat the guideline itself makes: at current GLP-1 pricing the cost-effectiveness analysis does not support broad use for cardiovascular prevention, though lower prices would. Care is tiered by comorbidity burden, from lifestyle alone up to multidisciplinary teams with a CKM coordinator.

The first ever AHA/ACC guideline dedicated to acute PE, published in Circulation on March 24, 2026 (epub February 19), written across 11 organizations including ACCP, ACEP, CHEST, SCAI, SHM, SIR, SVM and SVN.
The big change is the vocabulary: the old massive / submassive / low-risk language is replaced by the AHA/ACC Acute PE Clinical Categories, A through E with subcategories NEW, graded from low to high risk of adverse outcome. The point is that "submassive" lumped together patients whose management now diverges sharply.
Disposition follows the category. Category A (asymptomatic PE) can go home from the emergency department and does not need admission. Category C (symptomatic with an elevated severity score, elevated biomarkers and/or RV dysfunction), Category D (incipient cardiopulmonary failure) and Category E (cardiopulmonary failure with persistent hypotension) should be hospitalized.
Advanced therapy thresholds: systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy and surgical embolectomy are reasonable in Category E1 and may be considered in Categories D1 to D2. PE response teams (PERT) are recommended to improve the timeliness of these decisions, which is the part most likely to change how your hospital is organized rather than what you personally prescribe.

First major update since 2018. Released March 13, 2026 by ACC/AHA in conjunction with AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA. Retitled from "Blood Cholesterol" to "Dyslipidemia" to reflect broader scope (LDL + TG + remnants + Lp(a)). Core principle: "lower LDL for longer is better" -cumulative-exposure framing analogous to pack-years.
Risk calculator: PREVENT-ASCVD replaces the 2013 Pooled Cohort Equation. Validated ages 30-79, removes race as input, adds CKD/HbA1c/social deprivation, estimates 10- AND 30-year risk. Generally produces lower 10-yr estimates than PCE -especially in Black patients and the elderly.
New risk categories: Low <3% / Borderline 3-<5% / Intermediate 5-<10% / High ≥10% (replaces 2018's <5/5-7.5/7.5-20/≥20%).
Lower LDL targets in primary prevention NEW: PREVENT ≥10% → LDL <70. PREVENT 5-<10% → LDL <100. 2018 had no numeric primary-prev LDL goal -only "≥50% reduction."
Earlier statin starts: all HeFH at diagnosis (incl. children 8-10), age ≤30 with LDL ≥160, strong family hx of premature ASCVD, high 30-yr PREVENT risk. New "early intervention" category formalizes treating young high-LDL patients before age 40.
Routine apoB and Lp(a) testing: Lp(a) once per lifetime in all adults. ApoB when LDL goal met, especially TG ≥150, DM, or LDL <70. Goal apoB <55 in very-high-risk ASCVD.
Non-statin add-ons: reframed from strict ladder to parallel options (ezetimibe / bempedoic acid / PCSK9i mAb / inclisiran). Combination therapy is the rule, not the exception, for very-high-risk ASCVD. CLEAR Outcomes 2023 (bempedoic acid) and ORION (inclisiran) data drove this expansion.
HIV (REPRIEVE 2023): pitavastatin 4 mg cut MACE 35% in HIV patients age 40-75 below traditional LDL threshold -statin recommended for primary prevention in HIV regardless of LDL.

First major update since 2021. Published March 23, 2026 by SCCM/ESICM. 129 statements including 46 entirely new recommendations. Key changes:
Screening: NEWS/NEWS2/MEWS/SIRS now recommended over qSOFA for sepsis screening. qSOFA has poor sensitivity and should not be used as a sole screening tool. Sepsis remains a clinical diagnosis -no single biomarker can rule it in or out.
Fluids: Balanced crystalloids suggested over 0.9% saline. Initial bolus of at least 30 mL/kg IV crystalloid in first 3 hours for sepsis-induced hypoperfusion. Albumin not recommended as supplement to crystalloids. New guidance on fluid removal after resuscitation -a topic not previously addressed.
Vasopressors: Peripheral vasopressors OK to start -don't delay for central access. Norepinephrine remains first-line (downgraded from strong to conditional recommendation), then vasopressin, then epinephrine. MAP target ≥ 65 mmHg; new: MAP 60-65 for adults ≥ 65 years. Prolonged beta-lactam infusion now recommended (strong) for maintenance dosing.
Corticosteroids: IV hydrocortisone 200 mg/day suggested for septic shock with ongoing vasopressor requirement (maintained from 2021, which reversed the 2016 stance against routine steroids). Shortens shock duration but unclear mortality benefit. Trial enrollment (ADRENAL, APROCCHSS) used a ≥ 4h threshold, but no specific wait time is mandated.
Antibiotics: Broad-spectrum within 1 hour for septic shock, within 3 hours for sepsis without shock. Blood cultures before antibiotics when possible. New section on antibiotic optimization beyond just timing.
New topics: "Code sepsis" / sepsis huddle protocols suggested. Performance improvement programs recommended at institutional level. Post-sepsis discharge care including psychological and physical rehabilitation. Prehospital antibiotics may reduce mortality (OR 0.58, very low certainty).
Pediatric: 68-expert panel, 20 new topics. POCUS conditionally recommended to guide resuscitation. 30–40% of children surviving ICU-level sepsis face lasting health issues -long-term follow-up now addressed.

Annual update covering all aspects of diabetes care. Key 2026 changes: GLP-1 RA / dual GIP-GLP-1 (tirzepatide, semaglutide) elevated to first-line for obesity-related T2DM ahead of sulfonylureas / TZDs, especially when weight management is a goal.
SGLT2 inhibitors recommended for ALL patients with CKD (eGFR ≥ 20, regardless of A1c) -mirrors KDIGO 2024.
Continuous glucose monitoring (CGM) expanded to T2DM on any basal insulin (previously intensive insulin only). Time-in-range targets formalized.
DM screening starts at age 35 for all adults regardless of risk; age 25 if BMI ≥ 25 + risk factors (down from 35 with BMI criterion).
Inpatient targets: glucose 140-180 mg/dL most patients; basal-bolus preferred over sliding-scale-only; SQ insulin acceptable for mild-moderate DKA.
Lp(a) screening once per lifetime in adults with DM (mirrors ACC/AHA 2026 Dyslipidemia Guideline).
GLP-1 RA + SGLT2i preferred over insulin in many T2DM scenarios when ASCVD, HF, or CKD coexist -insulin is not "default escalation" anymore.

Annual update from the Global Initiative for Chronic Obstructive Lung Disease. Key 2026 refinements: biologics codified for severe eosinophilic COPD -mepolizumab, benralizumab (anti-IL-5/IL-5R), and dupilumab (anti-IL-4Rα) for patients with frequent exacerbations and blood eosinophils ≥ 300 cells/μL despite optimized inhaler triple therapy.
ABE classification (introduced 2023, refined further) -A (low symptom, low exacerbation risk), B (high symptom, low exacerbation), E (any exacerbations regardless of symptom). Old ABCD framework retired.
Inhaled triple therapy (LABA/LAMA/ICS) reserved for Group E with eos ≥ 300 OR persistent exacerbations on LABA/LAMA. ICS-without-LABA is not appropriate. Step-down to LABA/LAMA encouraged when eos low and stable.
Spirometry severity (GOLD 1-4) retained for FEV1 % predicted; symptoms (CAT, mMRC) and exacerbation history drive treatment, not GOLD stage alone.
Smoking cessation pharmacotherapy escalated -varenicline preferred, cytisinicline now available (newer agent), combination NRT (patch + short-acting) emphasized over patch alone.
Pulmonary rehab strongly emphasized post-exacerbation (within 4 weeks) -reduces 1-year mortality and rehospitalization.

First unified ACS guideline replacing the 2013 STEMI and 2014 NSTE-ACS guidelines. Biggest practice change: 1 month DAPT followed by ticagrelor monotherapy is now Class 1, LOE A (TWILIGHT, TICO, T-PASS), cuts major bleeding ~44% without raising ischemic risk. Ticagrelor or prasugrel preferred over clopidogrel post-PCI (clopidogrel is the preferred dual-therapy partner only when stacked on top of an OAC). For AFib + ACS + PCI: short triple therapy (1 to 4 weeks), then drop ASA, then OAC + clopidogrel through month 12 (Class 1; AUGUSTUS). LDL targets pushed lower: non-statin add-on if LDL ≥ 70 (Class 1), reasonable to intensify if LDL 55 to <70 (Class 2a). Intravascular imaging upgraded to Class 1 for PCI guidance. Complete revascularization Class 1 in multivessel disease (COMPLETE, MULTISTARS-AMI). Microaxial flow pump (Impella CP) Class 2a in select AMI cardiogenic shock per DanGer Shock 2024 (first positive shock RCT, 180-day mortality 45.8% vs 58.5%). Radial access preferred over femoral (Class 1; MATRIX). 0/1h and 0/2h hs-troponin algorithms formalized. → Full 2025 ACS Changes Comparison • → STEMI Topic • → NSTEMI Topic • → Read Full Guideline (Circulation)

Updated GFR categories and albuminuria staging. SGLT2 inhibitors now first-line for CKD with albuminuria regardless of diabetes status. Finerenone added for diabetic kidney disease. → CKD Topic

First major update since 2017. Replaces the prior hypertension guideline with updated evidence through 2025. Key changes include earlier risk stratification, expanded screening for secondary causes including primary aldosteronism, updated lifestyle and psychosocial intervention recommendations, and more individualized BP targets across the lifespan. Addresses tailored strategies for older adults, CKD, and resistant hypertension. → HTN Emergency Topic

First-ever IDSA guidelines for complicated UTIs. Provides a clinically relevant classification system for cUTI, stepwise approach to empiric antibiotic selection based on local resistance patterns, guidance on IV-to-oral antibiotic switch timing, and evidence-based duration of therapy. Addresses catheter-associated UTI, pyelonephritis with complicating factors, and urosepsis. → UTI Topic

ATS released updated community-acquired pneumonia guidelines. IDSA agreed with 8 of 10 recommendations but declined endorsement over antibiotic use in viral pneumonia. IDSA argues that nondiscriminatory antibiotic use in patients with positive respiratory virus tests (flu, RSV, COVID) confers more harm than benefit, since most do not have bacterial coinfection. Practice impact: think twice before reflexively adding antibiotics to confirmed viral CAP. → Pneumonia Topic

National Lipid Association moved Lp(a) from "consider checking in selected patients" to routine once-per-lifetime measurement in all adults. Lp(a) ≥50 mg/dL (or ≥125 nmol/L) is a major risk enhancer; Lp(a) ≥50 + established ASCVD = "very-high-risk" classification driving LDL goal <55. Statins don't lower Lp(a); PCSK9i and inclisiran lower it ~20-25%. Apheresis for refractory. Set the stage for the 2026 ACC/AHA Dyslipidemia Guideline adoption of routine Lp(a) testing. → Outpatient Lipid Management Topic

Updated management of immune-related adverse events from checkpoint inhibitors. Expanded guidance on steroid dosing, when to hold immunotherapy, and specialty referral triggers. → irAE Topic

Tirzepatide (Mounjaro) significantly reduced AHI in obese patients with OSA. Weight loss of ~20% with improvement in sleep apnea severity. May change first-line management of obesity-related OSA. → Obesity Topic

Replaced the 2012 Stable Ischemic Heart Disease guideline. New "Chronic Coronary Disease" (CCD) framework consolidates stable angina, post-MI/post-revasc, asymptomatic plaque, and silent ischemia into one umbrella. Key changes: SGLT2i and GLP-1 RA codified for ASCVD patients with DM (diabetes-class effect on MACE). ISCHEMIA trial integrated -no benefit of routine revascularization in stable CCD with moderate ischemia; med therapy first. Icosapent ethyl (REDUCE-IT) recommended for residual TG-driven ASCVD risk in patients with TG 150-499 on statin. DAPT duration after PCI individualized by bleeding/ischemic risk balance. Lifestyle reinforcement, depression screening, and structured cardiac rehab strongly recommended. → Stable Angina / CCD Topic

No difference between restrictive and liberal fluid strategies in early septic shock. Supports individualized fluid resuscitation over mandatory 30 mL/kg. → Sepsis Topic

Semaglutide reduced MACE by 20% in overweight/obese adults with CVD, regardless of diabetes status. First GLP-1 RA with cardiovascular benefit independent of diabetes. → Obesity Topic

Semaglutide improved symptoms, exercise function, and reduced body weight in obese HFpEF patients. New treatment paradigm -treating the obesity driving HFpEF. → HFpEF Topic

Rapid uptitration of all 4 GDMT pillars before discharge improved 180-day outcomes. Changed practice from slow sequential titration to rapid parallel initiation. → Heart Failure Topic

Aggressive LR resuscitation did not improve outcomes in acute pancreatitis and increased fluid overload. Goal-directed fluid therapy is now preferred. → Pancreatitis Topic

SGLT2 inhibitors now benefit ALL heart failure regardless of ejection fraction. Dapagliflozin reduced worsening HF and cardiovascular death in HFpEF. → HFpEF Topic

Empagliflozin reduced CKD progression and cardiovascular death regardless of diabetes status. SGLT2i now standard for CKD with albuminuria. → CKD Topic

30 mL/kg fluid bolus downgraded to weak recommendation. Balanced crystalloids suggested over NS. Hour-1 bundle replaces 3-hour and 6-hour bundles. Norepinephrine confirmed first-line vasopressor. → Sepsis Topic

33°C hypothermia showed no benefit over normothermia (36°C) after cardiac arrest. Aggressive fever prevention is what matters, not active cooling. Changed post-arrest temperature management. → Post-Cardiac Arrest Topic

Fidaxomicin (Dificid) now preferred over oral vancomycin for initial C. diff episodes -lower recurrence rate. Oral metronidazole is NO LONGER recommended for initial episodes. → C. difficile Topic

Trough-based monitoring (target 15-20 mcg/mL) replaced by AUC/MIC-guided dosing (target 400-600). AUC monitoring reduces nephrotoxicity by ~30% with equivalent efficacy. → Sepsis Topic

Early rhythm control (within 1 year of AF diagnosis) reduced cardiovascular death, stroke, and HF hospitalization vs rate control alone. Shifted the rate vs rhythm debate for newly diagnosed AF. → Atrial Fibrillation Topic

Early RRT initiation in AKI showed no benefit over a watchful waiting strategy. Delayed approach avoided unnecessary dialysis in ~50% of patients. Only start for absolute indications. → AKI Topic

Healthcare-Associated Pneumonia (HCAP) removed as a category. Led to massive overtreatment with unnecessarily broad antibiotics. Instead, assess individual MDR risk factors and use nasal MRSA PCR to guide de-escalation. → Pneumonia Topic

Oral antibiotics non-inferior to IV for bone and joint infections after initial IV therapy. Changed the dogma of "6 weeks IV only" for osteomyelitis. IV-to-oral step-down is now standard practice. → Osteomyelitis Topic