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Accuracy and prognostic value of American Heart Association: recommended depression screening in patients with coronary heart disease: data from the Heart and Soul Study.
Circ Cardiovasc Qual Outcomes 2011; 4(5):533-40CC

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+Show Affiliations

University of California San Francisco School of Medicine, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21862720

Citation

Elderon, Larkin, et al. "Accuracy and Prognostic Value of American Heart Association: Recommended Depression Screening in Patients With Coronary Heart Disease: Data From the Heart and Soul Study." Circulation. Cardiovascular Quality and Outcomes, vol. 4, no. 5, 2011, pp. 533-40.
Elderon L, Smolderen KG, Na B, et al. Accuracy and prognostic value of American Heart Association: recommended depression screening in patients with coronary heart disease: data from the Heart and Soul Study. Circ Cardiovasc Qual Outcomes. 2011;4(5):533-40.
Elderon, L., Smolderen, K. G., Na, B., & Whooley, M. A. (2011). Accuracy and prognostic value of American Heart Association: recommended depression screening in patients with coronary heart disease: data from the Heart and Soul Study. Circulation. Cardiovascular Quality and Outcomes, 4(5), pp. 533-40. doi:10.1161/CIRCOUTCOMES.110.960302.
Elderon L, et al. Accuracy and Prognostic Value of American Heart Association: Recommended Depression Screening in Patients With Coronary Heart Disease: Data From the Heart and Soul Study. Circ Cardiovasc Qual Outcomes. 2011;4(5):533-40. PubMed PMID: 21862720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy and prognostic value of American Heart Association: recommended depression screening in patients with coronary heart disease: data from the Heart and Soul Study. AU - Elderon,Larkin, AU - Smolderen,Kim G, AU - Na,Beeya, AU - Whooley,Mary A, Y1 - 2011/08/23/ PY - 2011/8/25/entrez PY - 2011/8/25/pubmed PY - 2012/1/27/medline SP - 533 EP - 40 JF - Circulation. Cardiovascular quality and outcomes JO - Circ Cardiovasc Qual Outcomes VL - 4 IS - 5 N2 - 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. SN - 1941-7705 UR - https://www.unboundmedicine.com/medline/citation/21862720/Accuracy_and_prognostic_value_of_American_Heart_Association:_recommended_depression_screening_in_patients_with_coronary_heart_disease:_data_from_the_Heart_and_Soul_Study_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.110.960302?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -