PT  - JOURNAL ARTICLE
AU  - Valentina Gonzalez-Jaramillo
AU  - Luisa Fernanda Arenas Ochoa
AU  - Clara Saldarriaga
AU  - Alicia Krikorian
AU  - John Jairo Vargas
AU  - Nathalia Gonzalez-Jaramillo
AU  - Steffen Eychmüller
AU  - Maud Maessen
TI  - The ‘Surprise question’ in heart failure: a prospective cohort study
AID  - 10.1136/bmjspcare-2021-003143
DP  - 2021 Aug 17
TA  - BMJ Supportive & Palliative Care
PG  - bmjspcare-2021-003143
4099  - http://spcare.bmj.com/content/early/2021/08/16/bmjspcare-2021-003143.short
4100  - http://spcare.bmj.com/content/early/2021/08/16/bmjspcare-2021-003143.full
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.Data are available upon reasonable request. Data are available upon request to the corresponding author.