We suggest referral to a specialist (cardiologist, pneumologist, allergologist, etc.) to make an accurate diagnosis and, if the patient's underlying condition can be improved, to set out a time scale and treatment regimen to obtain this improvement. Only at the end of this process, when the patient is ‘optimised’, can the anaesthetist make a prediction/estimate of the risk. (Evidence level:very Low；Recommendation grade:weak)

An expert anaesthetist should coordinate the preoperative evaluation involving a multidisciplinary team discussion when needed. (Evidence level:very Low；Recommendation grade:weak)

We suggest using the Revised Cardiac Risk Index (RCRI) score in preoperative patient risk stratification. (Evidence level:Low；Recommendation grade:weak)

When ordering preoperative blood tests, we suggest using natriuretic peptides as biological markers in high-risk patients (RCRI >2) undergoing high-risk surgery. (Evidence level:Low；Recommendation grade:weak)

We discourage using METs as a subjective measurement of the patient's functional capacity before medical decision-making. The preoperative patient-subjective estimate of METs correlates poorly with the METs measured by exercise stress testing. Nonetheless, in selected individuals, the preoperative assessment of patient-subjective METs is used as a surrogate marker of preoperative performance even if this is not seen as a substitute for preoperative cardiopulmonary testing. (Evidence level:High；Recommendation grade:Strong)

We recommend combining natriuretic peptides and Duke Activity Status Index questionnaires to evaluate cardiac reserve in high-risk patients undergoing high-risk surgery. (Evidence level:Low；Recommendation grade:Strong)

We recommend completing the WHO Disability Assessment Schedule 2.0 in high-risk patients before surgery as this could be useful to inform the patients about the risks of postoperative disability. (Evidence level:Low；Recommendation grade:Strong)

We suggest using a focused POCUS examination of the heart and lung, performed by a trained anaesthetist, in patients with any concerns regarding cardiovascular comorbidity before urgent or emergency surgery to address significant cardiac abnormalities and request a cardiology consultation and trigger more thorough cardiovascular monitoring, but it should not delay surgery. (Evidence level:moderate；Recommendation grade:weak)

There is no compelling evidence that a preoperative focused cardiac POCUS exam in patients with or without known chronic heart failure or coronary artery disease before elective high-risk surgery could reduce postoperative morbidity. (Evidence level:moderate；Recommendation grade:weak)

We recommend that preoperative antigen testing (detecting specific proteins on the surface of the SARS-CoV-2 virus) be performed only on symptomatic patients. (Evidence level:Low；Recommendation grade:Strong)