title: Accuracy and prognostic value of American Heart Association: recommended depression screening in patients with coronary heart disease: data from the Heart and Soul Study.
abstract: BACKGROUND- In 2008, the American Heart Association (AHA) recommended a 2-step screening method, consisting of the 2-item Patient Health Questionnaire (PHQ-2) followed by the 9-item Patient Health Questionnaire (PHQ-9), for identifying depression in cardiovascular patients. The accuracy and prognostic value of this screening method have not been evaluated. METHODS AND RESULTS- We administered the 2-step AHA-recommended screening algorithm to 1024 patients with stable coronary heart disease and calculated sensitivity and specificity against a gold standard interview for major depressive disorder. Subsequent cardiovascular events (myocardial infarction, stroke, transient ischemic attack, heart failure, or death) were determined during a mean of 6.27 ± 2.11 years of follow-up. The AHA-recommended screening method had high specificity (0.91; 95% confidence interval, 0.89 to 0.93) but low sensitivity (0.52; 95% confidence interval, 0.46 to 0.59) for a diagnosis of major depressive disorder. Participants who screened positive on the AHA depression protocol had a 55% greater risk of events than those who screened negative (age-adjusted hazard ratio, 1.55; 95% confidence interval, 1.21 to 1.97; P=0.0005). After adjustment for age, sex, body mass index, history of myocardial infarction, hypertension, diabetes, heart failure, and high-density lipoprotein levels, screening positive remained associated with a 41% greater rate of cardiovascular events (hazard ratio, 1.41; 95% confidence interval, 1.10 to 1.81; P=0.008). CONCLUSIONS- Among outpatients with stable coronary heart disease, the AHA-recommended depression screening protocol is highly specific for depression and identifies patients at risk for adverse cardiovascular outcomes.
authors.affiliation: University of California San Francisco School of Medicine, USA.
authors.forename: Larkin
authors.initials: L
authors.lastname: Elderon
authors.forename: Kim G
authors.initials: KG
authors.lastname: Smolderen
authors.forename: Beeya
authors.initials: B
authors.lastname: Na
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000368:Aged; D000572:American Heart Association; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D003863:Depression; D003865:Major Depressive Disorder / Q000453:epidemiology*; D003955:Diagnostic Tests, Routine / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards; D016019:Survival Analysis; D014481:United States