The ‘Surprise question’ in heart failure: a prospective cohort study

Abstract

ObjectiveThe Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ’s performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ’s performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications.MethodsWe conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan’s nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class.ResultsWe observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ’s performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV.ConclusionsWe consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy.

Enhancing Palliative Care for Patients With Advanced Heart Failure Through Simple Prognostication Tools: A Comparison of the Surprise Question, the Number of Previous Heart Failure Hospitalizations, and the Seattle Heart Failure Model for Predicting 1-Year Survival

“…Straw et al ( 9 ) studied 129 patients hospitalized with acute HF and found a sensitivity of 0.88, which was comparable to our findings [sensitivity 0.84 (0.74–0.91 95% CI)], and a specificity of 0.59, which was significantly higher than in our study [specificity 0.33 (0.28–0.37 95% CI)]. Gonzalez-Jaramillo et al ( 10 ) studied 174 patients recruited from an HF clinic and found a sensitivity of 0.85 (0.69–1.00 95% CI), and a specificity of 0.57 (0.49–0.65 95% CI). Overall, our findings are in line with previous research.…”

Patient Identification for Serious Illness Conversations: A Scoping Review

“…A major advantage of the SQ is that it encourages a level of closeness between the clinician and the patient, prompting active contemplation of the patient’s unique situation and care needs [ 26 ]. It is, however, important to note that the SQ has reported mixed sensitivity (low to reasonable/good), and responses to the question are said to be impacted by the clinician’s familiarity with both the question and the patient [ 50 , 55 , 56 , 57 ]. Furthermore, repeatedly asking oneself the SQ is not only time consuming but can be emotionally exhausting given the gravity of the overarching topic [ 12 , 58 ].…”

Palliative care and COVID-19: a bibliometric analysis

“…8 Although the clinicians are more and more focusing also on patients with no malignant-disease it remains a lack, especially in the research in this field. Additionally, difficulties in the prognosis of non-cancerdisease could explain this phenomenon [12][13][14] In many patients with chronic non-oncological diseases, the perception of disease severity and prognosis is not congruent with the real one, decreasing the likelihood that patients will ask for PC or that the physician will offer it to them. 15 Furthermore, physicians report other barriers to providing PC that are accentuated in non-oncological diseases.…”

“…15 Furthermore, physicians report other barriers to providing PC that are accentuated in non-oncological diseases. [12][13][14] This, despite the exhortation in doing more research about those conditions even beyond the end of life. 13 16 In the clinical practice patients with cancer are more prompt to be referred to PC than non-oncological one.…”