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Predicting one-year mortality in heart failure using the 'Surprise Question': a prospective pilot study
Sam Straw1, Rowenna Byrom2, John Gierula2
1Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
European Journal of Heart Failure
|December 15, 2018
Summary
The Surprise Question accurately identifies most heart failure patients nearing the end of life. This simple prognostic tool is effective for doctors and nurses in predicting one-year mortality risk.
Area of Science:
- Cardiology
- Geriatrics
- Palliative Care
Background:
- The Surprise Question predicts mortality in chronic kidney disease and cancer patients.
- Its utility in heart failure prognosis is not well-established.
Purpose of the Study:
- To evaluate the Surprise Question's ability to identify heart failure patients with a prognosis of less than one year.
- To assess its applicability across different healthcare professionals.
Main Methods:
- Prospective study of 129 decompensated heart failure patients.
- Doctors and nurses assessed patients using the Surprise Question.
- Follow-up for death or one year; survival analysis performed.
Main Results:
- The Surprise Question demonstrated high sensitivity (0.85) and negative predictive value (0.88) for predicting one-year mortality.
- Specificity (0.59) and positive predictive value (0.52) were moderate.
- Similar accuracy was observed between cardiologists and specialist nurses.
- The Surprise Question was significantly associated with all-cause mortality (HR 2.8, P=0.046).
Conclusions:
- The Surprise Question effectively identifies heart failure patients likely to die within one year.
- It accurately identifies patients unlikely to die, despite some over-classification.
- The tool is valuable for prognostication in heart failure care across disciplines.
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