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Published on: June 10, 2025
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The 'Surprise question' in heart failure: a prospective cohort study
Valentina Gonzalez-Jaramillo1,2, Luisa Fernanda Arenas Ochoa3, Clara Saldarriaga3,4
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland valentina.gonzalez@ispm.unibe.ch.
BMJ Supportive & Palliative Care
|August 18, 2021
Summary
The Surprise Question (SQ) effectively identifies ambulatory heart failure patients nearing end-of-life. Its accuracy varies by age, ejection fraction, and NYHA class, aiding early palliative care discussions.
Area of Science:
- Cardiology
- Geriatrics
- Palliative Care
Background:
- The Surprise Question (SQ) is a prognostic tool for identifying patients with limited life expectancy.
- Ambulatory heart failure (HF) patients require accurate prognostic screening for timely interventions.
Purpose of the Study:
- To evaluate the performance of the SQ in predicting 1-year mortality in ambulatory HF clinics.
- To determine how demographic and clinical factors influence SQ accuracy.
Main Methods:
- Prospective cohort study in two HF clinics.
- Calculated sensitivity, specificity, likelihood ratios, and predictive values for the SQ.
- Utilized Fagan's nomograms to visualize mortality probability changes.
- Analyzed overall and subgroup performance based on sex, age, LVEF, and NYHA class.
Main Results:
- The SQ demonstrated 85% sensitivity in identifying HF patients in their last year of life.
- SQ performance was consistent between sexes.
- The SQ was more accurate in patients under 70, with reduced LVEF, and NYHA class III/IV.
Conclusions:
- The SQ is a rapid screening tool for identifying ambulatory HF patients who may need advance care planning or palliative care referrals.
- The tool aids in initiating crucial end-of-life discussions for patients with limited life expectancy.
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