Straw, S, Byrom, R, Gierula, J et al. (6 more authors) (2019) Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study. European Journal of Heart Failure, 21 (2). pp. 227-234. ISSN 1388-9842
Abstract
Background: The Surprise Question: ‘would you be surprised if this patient were to die within the next year?’ has been shown to predict mortality in patients with chronic kidney disease and cancer. This prospective study aimed to determine whether the Surprise Question could identify heart failure patients with a prognosis of less than 1 year, and whether the Surprise Question can be used by different healthcare professionals.
Methods and results: Overall, 129 consecutive patients admitted with decompensated heart failure were included. Doctors and nurses were asked to provide a ‘surprised’ or ‘not surprised’ response to the Surprise Question for each patient. Patients were followed up until death or 1 year following study inclusion. The sensitivity, specificity, positive predictive value and negative predictive value of the Surprise Question were assessed. Cox regression was used to determine covariates significantly associated with survival. The Surprise Question showed excellent sensitivity (0.85) and negative predictive value (0.88) but only fair specificity (0.59) and positive predictive value (0.52) when asked of cardiologists. There were similar levels of accuracy between doctors and specialist nurses. The Surprise Question was significantly associated with all‐cause mortality in multivariate regression analysis (hazard ratio 2.8, 95% confidence interval 1.0–7.9, P = 0.046).
Conclusion: This study demonstrates that the Surprise Question can identify heart failure patients within the last year of life. Despite over‐classification of patients into the ‘not surprised’ category, the Surprise Question identified nearly all patients who were within the last year of life, whilst also accurately identifying those unlikely to die.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology. This is the peer reviewed version of the following article: Straw, S. , Byrom, R. , Gierula, J. , Paton, M. F., Koshy, A. , Cubbon, R. , Drozd, M. , Kearney, M. and Witte, K. K. (2018), Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study. Eur J Heart Fail, which has been published in final form at https://doi.org/10.1002/ejhf.1353. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Surprise Question; Heart failure; Palliative care |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Discovery & Translational Science Dept (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research NIHR-CS--012-032 |
Depositing User: | Symplectic Publications |
Date Deposited: | 07 Jan 2019 15:59 |
Last Modified: | 11 Dec 2019 01:39 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1002/ejhf.1353 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:140475 |