title: Comparative potential of the 2-item versus the 9-item patient health questionnaire to predict death or rehospitalization in heart failure.
abstract: BACKGROUND
  Depression is common in heart failure and associated with adverse clinical outcomes. We investigated the potential of the 2-item patient health questionnaire (PHQ-2) versus that of the 9-item version (PHQ-9) to predict death or rehospitalization.
  
  
  RESULTS
  Participants of the Interdisciplinary Network for Heart Failure program were eligible, if they completed the PHQ-9 during baseline assessment. All participants were hospitalized for cardiac decompensation and had a left ventricular ejection fraction ≤40% before discharge. PHQ-2 scores were extracted from the answers to the first 2 PHQ-9 questions. To analyze associations of PHQ-2 and PHQ-9 with both, death and rehospitalization, univariable Cox regression models were used. To compare screening efficacy of both tools, c-statistics were computed. The sample consisted of 852 patients, (67.6±12.1 years; 27.7% women; 42.3% New York Heart Association class III/IV). Follow-up was 18 months (100% complete). During follow-up, 152 patients died and 482 were rehospitalized. Both, PHQ-2 and PHQ-9, predicted death in univariable analysis (hazard ratio, 1.18; 95% confidence interval, 1.09-1.29; P<0.001 and hazard ratio, 1.07; 95% confidence interval, 1.04-1.09; P<0.001, respectively), as well as rehospitalization (hazard ratio, 1.07; confidence interval, 1.01-1.21; P=0.02 and hazard ratio, 1.03; confidence interval, 1.01-1.04; P=0.001, respectively). These results were confirmed by c-statistics.
  
  
  CONCLUSIONS
  In univariable models and confirmed by c-statistics the potential of both PHQ-2 and PHQ-9 to predict death and hospitalization was similar. In clinical practice, PHQ-2 screening seems thus sufficiently reliable and more feasible than the time-consuming PHQ-9 to identify patients at an increased risk of adverse outcomes.
  
  
  BACKGROUND
  URL: http://www.controlled-trials.com. Unique identifier: ISRCTN 23325295.
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
authors: Sven M
authors: SM
authors: Piepenburg
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
authors: Hermann
authors: H
authors: Faller
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
authors: Götz
authors: G
authors: Gelbrich
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
authors: Stefan
authors: S
authors: Störk
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
authors: Bodo
authors: B
authors: Warrings
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
authors: Georg
authors: G
authors: Ertl
authors: From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany. Angermann_C@ukw.de.
authors: Christiane E
authors: CE
authors: Angermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: comorbidity; depression; heart failure; mortality