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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 Sep; 4(5):533-40.CC

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.No affiliation info availableNo affiliation info availableNo affiliation info available

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), 533-40. https://doi.org/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 -