ArticleBMJ supportive & palliative care2024
The 'Surprise question' in heart failure: a prospective cohort study.
Article in BMJ supportive & palliative care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis.BMJ supportive & palliative care · 2024Pooled it
- Palliative Care Needs Assessment Using the Surprise Question in Hospitalized Patients With Heart Failure.Journal of the American Heart Association · 2025Observational
- Palliative Care and Hospice for Heart Failure Patients: Position Statement From the Korean Society of Heart Failure.International journal of heart failure · 2025Review
- National strategy for integrating palliative care into standard cardiac care for people living with heart failure: a position statement from the joint working group of the Swiss Societies of Cardiology and Palliative Care.Frontiers in cardiovascular medicine · 2025Article
- 'Acute Heart Failure': Should We Abandon the Term Altogether?Current heart failure reports · 2022Review
- The Surprise Question as a Trigger for Primary Palliative Care Interventions for Children with Advanced Heart Disease.Pediatric cardiology · 2022Article
- Patient Identification for Serious Illness Conversations: A Scoping Review.International journal of environmental research and public health · 2022Article
- Enhancing Palliative Care for Patients With Advanced Heart Failure Through Simple Prognostication Tools: A Comparison of the Surprise Question, the Number of Previous Heart Failure Hospitalizations, and the Seattle Heart Failure Model for Predicting 1-Year Survival.Frontiers in cardiovascular medicine · 2022Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe 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.
methodsWe 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.
resultsWe 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.
conclusionsWe 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.
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