{
  "abstract": "Introduction Patients with chronic heart failure experience a burden of symptoms comparable with many forms of cancer. 1 Palliative care provides a holistic approach to symptom management but is underutilised.2 3 The ‘Surprise Question’: ‘Would you be surprised if this patient were to die within the next year?’ reliably identifies patients hospitalized with heart failure who have a poor prognosis.4 However, it is unclear whether this question identifies frailty or palliative care needs, which are important criterion for specialist palliative care referral beyond prognosis. We aimed to assess whether Heart Failure Nurse Specialist responses to the Surprise Question were associated with palliative care needs.Methods Patients hospitalized for heart failure who were assessed by a Heart Failure Nurses Specialist (HFNS) during their admission were eligible for inclusion. We first posed the Surprise Question to the HFNS and then recorded frailty using the Rockwood Frailty Score and assessed palliative care needs using the Needs Assessment Tool: Progressive Disease – Heart Failure (NAT:PD-HF). We report the proportions of patients with needs identified for each domain, comparing those who received a ‘surprised’ and a ‘not surprised’ response.Results Of the ten assessments completed, six returning a ‘not surprised’ response. Patients receiving a ‘not surprised’ response had higher median Rockwood frailty scores (3 vs 5.5). The NAT:PD-HF assesses the level of concern in a range of patient and carer domains. All patients receiving a ‘not surprised’ response had potential unmet needs in all patient domains including physical, psychological, spiritual and practical, with a significant level of concern in 40% of domains. In comparison, potential needs were identified in only 30% of domains for patients receiving a ‘surprised’ response. In addition, carers of patients receiving a ‘not surprised’ response had unmet needs in 87% of domains compared to 37% for carers of ‘surprised’ response patients.Conclusions Our initial data suggests that patients and carers of those receiving a ‘not surprised’ from their HFNS are more likely to have unmet palliative care needs. This represents both an indication of unmet needs and the potential for improving the quality of life for a highly symptomatic population. Further work will inform the development of a behaviour intervention to assess whether the Surprise Question when implemented into routine clinical care improves access to specialist palliative care services, and whether this translates to improved quality of life for heart failure patients and their families.References O'Leary, et al. EJHF 2009.World Health Organisation, 2020. online.Cheung, et al. J Pain Symptom Management 2013.Straw, et al. EJHF 2019.",
  "authors": [
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK"
      ],
      "name": "Ruth Burgess"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK"
      ],
      "name": "Melanie McGinlay"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK"
      ],
      "name": "Sarah Winsor"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK"
      ],
      "name": "Emma Goodman"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK"
      ],
      "name": "Georgina Davison"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK"
      ],
      "name": "Isabelle Simmons"
    },
    {
      "affiliations": [
        "St Gemma’s Hospice Academic Unit, Leeds, UK"
      ],
      "name": "Lucy Ziegler"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Trust, Leeds, UK",
        "Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK"
      ],
      "name": "Sam Straw"
    }
  ],
  "title": "3-002 Does the ‘surprise question’ identify palliative care needs in chronic heart failure?",
  "uid": "959a9106-9c96-555e-b640-4dab3ba6d707"
}