Which patients with heart failure should receive specialist palliative care?

Campbell, Ross T.; Petrie, Mark C.; Jackson, Colette E.; Jhund, Pardeep S.; Wright, Ann; Gardner, Roy S.; Sonecki, Piotr; Pozzi, Andrea; McSkimming, Paula; McConnachie, Alex; Finlay, Fiona; Davidson, Patricia M.; Denvir, Martin A.; Johnson, Miriam J.; Hogg, Karen; McMurray, John J.V.

doi:10.1002/ejhf.1240

Cited by 68 publications

(92 citation statements)

References 29 publications

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“…European guidelines recommend an early consideration of a symptom focused approach, and point towards indicators such as repeated hospitalisation and frailty as drivers for such decisions . Up to a quarter of patients hospitalised with heart failure may require specialist palliative care services, and a short remaining life span remains a major driver in their delivery . The effect of the Surprise Question on the delivery and impact on specialist palliative care services was not assessed by this study.…”

Section: Discussionmentioning

confidence: 96%

Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study

Straw

Byrom

Gierula

et al. 2018

European J of Heart Fail

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Background 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. Methods and results 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). Conclusion 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.

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Section: Discussionmentioning

confidence: 96%

Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study

Straw

Byrom

Gierula

et al. 2018

European J of Heart Fail

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“…Palliative care of patients with advanced HF is still underused in most of the hospitals . Straw et al .…”

Section: Disease Managementmentioning

confidence: 99%

“…Palliative care of patients with advanced HF is still underused in most of the hospitals. 17,18 Straw et al 19 used the Surprise Question: 'would you be surprised if this patient were to die within the next year?' to predict mortality in 129 patients with acute HF.…”

Section: The 'Surprise Question' and Selection For Palliative Carementioning

confidence: 99%

February 2019 at a glance: pathophysiology, exercise capacity, diuretics and valve disease

Metra

2019

European J of Heart Fail

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“…In this issue of the Journal, Campbell and colleagues present findings that can help us to improve care for chronic heart failure patients . In this article the authors present a definition of need for specialized palliative care in patients hospitalized with heart failure using patient‐reported outcome measures.…”

mentioning

confidence: 99%

“…A Kansas City Cardiomyopathy Questionnaire (KCCQ) Summary Score of <29 identified patients who subsequently had specialist palliative care needs. Such a score can help to target patients who might need to be referred to specialist palliative care services and therefore contribute to optimization of quality of care …”

mentioning

confidence: 99%

Talking about palliative care in heart failure

Jaarsma

Wal

Hjelmfors

et al. 2018

European J of Heart Fail

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Which patients with heart failure should receive specialist palliative care?

Abstract: A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services.

Cited by 68 publications

References 29 publications

Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study

Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study

February 2019 at a glance: pathophysiology, exercise capacity, diuretics and valve disease

Talking about palliative care in heart failure

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