title: Patient Health Questionnaire-9 score and adverse cardiac outcomes in patients hospitalized for acute cardiac disease.
abstract: OBJECTIVE
  The Patient Health Questionnaire-9 (PHQ-9) is increasingly used as a depression assessment tool in cardiac patients. However, in contrast to older depression instruments, there is little data linking PHQ-9 scores to adverse cardiac outcomes. Our goal was to evaluate whether higher PHQ-9 scores were predictive of subsequent cardiac readmissions among depressed patients hospitalized for an acute cardiac event.
  
  
  METHODS
  Patients diagnosed with depression during hospitalization for acute coronary syndrome, heart failure, or arrhythmia were enrolled in a randomized depression management trial. Participants were administered PHQ-9 at enrollment, and data was collected regarding cardiac readmissions and mortality over the next 6months. To evaluate the independent association of PHQ-9 score with subsequent cardiac readmission, Cox regression analysis that included relevant sociodemographic and medical covariates was used. Survival analysis examining time to first event, stratified by quartile of initial PHQ-9 score, was performed using Kaplan-Meier curves and log-rank test for trend. Analyses were then repeated using a composite (cardiac readmission or mortality) outcome.
  
  
  RESULTS
  Among 172 subjects, 62 (36.0%) had a cardiac-related rehospitalization. Higher initial PHQ-9 score predicted cardiac-related rehospitalization, independent of multiple relevant covariates (hazard ratio 1.09 [95% confidence interval=1.02-1.17]; p=0.015). On survival analysis, log-rank test for trend revealed a significant rise in event rates across increasing PHQ-9 quartiles (χ(2)=6.36; p=0.012). Findings were similar (p<.05) for the composite outcome.
  
  
  CONCLUSIONS
  In depressed cardiac patients, each additional point on the PHQ-9 was independently associated with a 9% greater risk of cardiac readmission over the subsequent 6months.
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Beach
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mastromauro
authors.forename: Brian C
authors.initials: BC
authors.lastname: Healy
authors.forename: Eleanor E
authors.initials: EE
authors.lastname: Beale
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality*; D000368:Aged; D003863:Depression / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D013997:Time Factors
keywords: Cardiovascular disease; Depression; Patient Health Questionnaire-9