Palliative Care Needs Assessment Using the Surprise Question in Hospitalized Patients With Heart Failure

The surprise question "Would I be surprised if this patient dies within 1 year?" is a simple tool to identify patients who may benefit from palliative care. We aimed to investigate the usefulness of the surprise question to identify palliative care needs among patients hospitalized with heart failure (HF).

This study used a prospective observational registry that includes consecutive patients hospitalized with HF using the surprise question on admission. Patients were classified as surprised or not surprised according to the surprise question. Backgrounds, symptom burdens, and clinical outcomes were compared between groups. Of 601 patients hospitalized with HF, 181 (30%) were classified as not surprised. Patients classified as not surprised were older (86±8 versus 76±12 years, P<0.001), had a lower prevalence of men (76 [42%] versus 238 [57%], P=0.001), and had a lower left ventricular ejection fraction (41±19% versus 45±17%, P=0.015) than those classified as surprised. There were no significant differences in symptom burdens evaluated at discharge or their temporal change from admission to discharge between groups (all P>0.05). Among 489 patients followed until death or 1 year after admission, 108 (22%) all-cause deaths and 90 (18%) HF rehospitalizations occurred within 1 year. The multivariable Cox model demonstrated the independent association between the not surprised classification and higher risk of all-cause death (hazard ratio [HR], 3.34 [95% CI, 2.03-5.49]; P<0.001), whereas there was no association with HF rehospitalization (HR, 1.36 [95% CI, 0.79-2.34]; P=0.27).

The surprise question was significantly associated with a higher risk of all-cause death, suggesting its prognostic usefulness in identifying patients suitable for advance care planning.