The 'Surprise question' in heart failure: a prospective cohort study.

Gonzalez-Jaramillo, Valentina; Arenas Ochoa, Luisa Fernanda; Saldarriaga, Clara; Krikorian, Alicia; Vargas, John Jairo; Gonzalez-Jaramillo, Nathalia; Eychmüller, Steffen; Maessen, Maud (2021). The 'Surprise question' in heart failure: a prospective cohort study. (In Press). BMJ supportive & palliative care BMJ Publishing Group 10.1136/bmjspcare-2021-003143

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The 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.


We 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.


We 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.


We 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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Gonzalez Jaramillo, Valentina; Gonzalez Jaramillo, Nathalia; Eychmüller, Steffen and Maessen, Maud


300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health




BMJ Publishing Group




Doris Kopp Heim

Date Deposited:

30 Aug 2021 17:17

Last Modified:

30 Aug 2021 17:42

Publisher DOI:


PubMed ID:


Additional Information:

Eychmüller and Maessen contributed equally to this work.

Uncontrolled Keywords:

clinical decisions heart failure prognosis supportive care terminal care




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