Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Eur J Heart Fail. 2019 Feb;21(2):227-234. doi: 10.1002/ejhf.1353. Epub 2018 Dec 11.
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.
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).
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.
“如果这位患者在接下来的一年中去世，你会感到惊讶吗？”这个问题（即“Surprise Question”）已被证明可以预测患有慢性肾病和癌症的患者的死亡率。本前瞻性研究旨在确定“Surprise Question”是否可以识别出预期寿命不到 1 年的心力衰竭患者，以及该问题是否可以由不同的医疗保健专业人员使用。
共纳入 129 例因失代偿性心力衰竭入院的连续患者。医生和护士被要求对每位患者的“Surprise Question”回答“惊讶”或“不惊讶”。对患者进行随访，直至死亡或研究纳入后 1 年。评估了“Surprise Question”的敏感性、特异性、阳性预测值和阴性预测值。Cox 回归用于确定与生存显著相关的协变量。当询问心脏病专家时，“Surprise Question”表现出出色的敏感性（0.85）和阴性预测值（0.88），但特异性（0.59）和阳性预测值（0.52）仅为中等水平。医生和专科护士的准确性水平相似。多变量回归分析显示，“Surprise Question”与全因死亡率显著相关（危险比 2.8，95%置信区间 1.0-7.9，P=0.046）。
本研究表明，“Surprise Question”可以识别生命最后一年的心力衰竭患者。尽管患者被过度分类为“不惊讶”类别，但“Surprise Question”几乎可以识别出所有生命最后一年的患者，同时也准确识别出那些不太可能死亡的患者。
