Hamatani Yasuhiro, Ikeyama Yurika, Kunugida Atsuko, Ishigami Kenjiro, Minami Kimihito, Takamoto Mina, Yamaguchi Mitsuyo, Sakai Misaki, Kinoshita Tae, Iguchi Moritake, Akao Masaharu
Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan.
Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan.
J Am Heart Assoc. 2025 Apr 15;14(8):e037769. doi: 10.1161/JAHA.124.037769. Epub 2025 Mar 30.
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, <0.001), had a lower prevalence of men (76 [42%] versus 238 [57%], =0.001), and had a lower left ventricular ejection fraction (41±19% versus 45±17%, =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 >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]; <0.001), whereas there was no association with HF rehospitalization (HR, 1.36 [95% CI, 0.79-2.34]; =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.
“如果该患者在1年内死亡，我会感到惊讶吗？”这个意外问题是一种识别可能从姑息治疗中获益的患者的简单工具。我们旨在研究该意外问题在识别因心力衰竭（HF）住院患者的姑息治疗需求方面的有用性。
本研究使用了一个前瞻性观察登记系统，纳入了入院时使用意外问题的连续HF住院患者。根据意外问题，患者被分类为感到惊讶或不感到惊讶。比较了两组之间的背景、症状负担和临床结局。在601例HF住院患者中，181例（30%）被分类为不感到惊讶。与被分类为感到惊讶的患者相比，被分类为不感到惊讶的患者年龄更大（86±8岁对76±12岁，<0.001），男性患病率更低（76例[42%]对238例[57%]，=0.001），左心室射血分数更低（41±19%对45±17%，=0.015）。两组之间出院时评估的症状负担或从入院到出院的时间变化没有显著差异（均>0.05）。在489例随访至死亡或入院后1年的患者中，108例（22%）全因死亡和90例（18%）HF再住院发生在1年内。多变量Cox模型显示，不感到惊讶的分类与全因死亡风险较高独立相关（风险比[HR]，3.34[95%CI，2.03 - 5.49]；<0.001），而与HF再住院无关（HR，1.36[95%CI，0.79 - 2.34]；=0.27）。
意外问题与全因死亡风险较高显著相关，表明其在识别适合提前护理规划的患者方面具有预后有用性。
