The Surprise Question Can Be Used to Identify Heart Failure Patients in the Emergency Department Who Would Benefit From Palliative Care.

Abstract

CONTEXT\nHeart failure (HF) is associated with symptom exacerbations and risk of mortality after an emergency department (ED) visit. Although emergency physicians (EPs) treat symptoms of HF, often the opportunity to connect with palliative care is missed. The surprise question (SQ) Would you be surprised if this patient died in the next 12\xa0months? is a simple tool to identify patients at risk for 12-month mortality.\n\n\nOBJECTIVES\nThe objective of this study was to assess the accuracy of the SQ when used by EPs to assess patients with HF.\n\n\nMETHODS\nWe conducted a prospective cohort study in which clinicians applied the SQ to patients presenting to the ED with symptoms of HF. Chart review and review of death records were completed. The primary outcome was accuracy of the surprise question to predict 12-month mortality. A univariate analysis for potential predictors of 12-month mortality was performed.\n\n\nRESULTS\nDuring the study period, 199 patients were identified, and complete data were available for 97% of observations (n\xa0=\xa0193). The one-year mortality was 29%. EPs reported that they would not be surprised if the patient died within the next 12\xa0months in 53% of cases. 42.7% of these patients died within 12\xa0months compared to 13.3% in the would be surprised group. There was a strong association with death in the not surprised group (odds ratio 4.85, 95% CI 2.34-9.98, P\xa0<\xa00.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of the SQ were 78.6%, 56.9%, 42.7%, and 86.7%, respectively, with c-statistic\xa0=\xa00.68.\n\n\nCONCLUSION\nThe SQ screening tool can assist ED providers in identifying HF patients that would benefit from early palliative care involvement.