PMID- 34404746
OWN - NLM
STAT- MEDLINE
DCOM- 20240223
LR  - 20240228
IS  - 2045-4368 (Electronic)
IS  - 2045-435X (Print)
IS  - 2045-435X (Linking)
VI  - 14
IP  - 1
DP  - 2024 Feb 21
TI  - The 'Surprise question' in heart failure: a prospective cohort study.
PG  - 68-75
LID - 10.1136/bmjspcare-2021-003143 [doi]
AB  - OBJECTIVE: The 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. METHODS: We 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. RESULTS: We 
      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. CONCLUSIONS: We 
      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.
CI  - (c) Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Gonzalez-Jaramillo, Valentina
AU  - Gonzalez-Jaramillo V
AUID- ORCID: 0000-0002-2470-7022
AD  - Institute of Social and Preventive Medicine, University of Bern, Bern, 
      Switzerland valentina.gonzalez@ispm.unibe.ch.
AD  - Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
FAU - Arenas Ochoa, Luisa Fernanda
AU  - Arenas Ochoa LF
AD  - Cardiology, Clinica Cardio VID, Medellin, Colombia.
FAU - Saldarriaga, Clara
AU  - Saldarriaga C
AD  - Cardiology, Clinica Cardio VID, Medellin, Colombia.
AD  - Cardiology, University of Antioquia, Medellin, Colombia.
FAU - Krikorian, Alicia
AU  - Krikorian A
AUID- ORCID: 0000-0003-2118-5692
AD  - School of Health Sciences, Pontifical Bolivarian University, Medellin, Colombia.
FAU - Vargas, John Jairo
AU  - Vargas JJ
AD  - School of Health Sciences, Pontifical Bolivarian University, Medellin, Colombia.
AD  - Institute of Cancerology, Las Americas Clinic, Medellin, Colombia.
FAU - Gonzalez-Jaramillo, Nathalia
AU  - Gonzalez-Jaramillo N
AD  - Institute of Social and Preventive Medicine, University of Bern, Bern, 
      Switzerland.
AD  - Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
FAU - Eychmuller, Steffen
AU  - Eychmuller S
AD  - University Center for Palliative Care, Inselspital University Hospital Bern, 
      University of Bern, Bern, Switzerland.
FAU - Maessen, Maud
AU  - Maessen M
AD  - Institute of Social and Preventive Medicine, University of Bern, Bern, 
      Switzerland.
AD  - University Center for Palliative Care, Inselspital University Hospital Bern, 
      University of Bern, Bern, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20240221
PL  - England
TA  - BMJ Support Palliat Care
JT  - BMJ supportive & palliative care
JID - 101565123
SB  - IM
MH  - Male
MH  - Humans
MH  - Female
MH  - Aged
MH  - Stroke Volume
MH  - Prospective Studies
MH  - *Ventricular Function, Left
MH  - *Heart Failure/diagnosis
MH  - Palliative Care/methods
MH  - Prognosis
PMC - PMC10894837
OTO - NOTNLM
OT  - clinical decisions
OT  - heart failure
OT  - prognosis
OT  - supportive care
OT  - terminal care
COIS- Competing interests: None declared.
EDAT- 2021/08/19 06:00
MHDA- 2024/02/23 06:43
PMCR- 2024/02/26
CRDT- 2021/08/18 05:48
PHST- 2021/04/22 00:00 [received]
PHST- 2021/07/24 00:00 [accepted]
PHST- 2024/02/23 06:43 [medline]
PHST- 2021/08/19 06:00 [pubmed]
PHST- 2021/08/18 05:48 [entrez]
PHST- 2024/02/26 00:00 [pmc-release]
AID - bmjspcare-2021-003143 [pii]
AID - 10.1136/bmjspcare-2021-003143 [doi]
PST - epublish
SO  - BMJ Support Palliat Care. 2024 Feb 21;14(1):68-75. doi: 
      10.1136/bmjspcare-2021-003143.