The 'not surprised' classification on the surprise question was independently associated with a higher risk of all-cause death (HR 3.34; 95% CI 2.03-5.49; P<0.001) in hospitalized HF patients.
Observational (n=601)
Does the 'not surprised' classification using the surprise question predict all-cause death and heart failure rehospitalization in patients hospitalized with heart failure?
The surprise question is a simple and effective prognostic tool to identify hospitalized heart failure patients at high risk of 1-year mortality who may benefit from advance care planning.
Effect estimate: HR 3.34 (95% CI 2.03-5.49)
p-value: p=<0.001
Background 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). Methods and Results 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 0.05). 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). Conclusions 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.
Hamatani et al. (Mon,) conducted a observational in Heart failure (HF) (n=601). "Not surprised" classification (Surprise question) vs. "Surprised" classification was evaluated on All-cause death (HR 3.34, 95% CI 2.03-5.49, p=<0.001). The 'not surprised' classification on the surprise question was independently associated with a higher risk of all-cause death (HR 3.34; 95% CI 2.03-5.49; P<0.001) in hospitalized HF patients.