Abstract P113: Accuracy and Prognostic Value of AHA-Recommended Depression Screening in Patients with Coronary Heart Disease from the Heart and Soul Study

Accuracy and prognostic value of AHA-recommended depression screening in patients with coronary heart disease from the Heart & Soul Study Background- In 2008, the American Heart Association (AHA) recommended a two-step screening method, consisting of the two-item Patient Health Questionnaire (PHQ-2) followed by the nine-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 two-step AHA-recommended screening algorithm to 1024 patients with stable CHD and calculated sensitivity and specificity against a gold standard interview for major depressive disorder (MDD). Subsequent cardiovascular events (myocardial infarction, stroke, transient ischemic attack, heart failure or death) were determined during a mean of 6.27 ± 2.11 years follow-up. The AHA-recommended screening method had high specificity (0.91, 95% CI 0.46-0.59), but low sensitivity (0.52, 95% CI 0.89-0.93) for a diagnosis of MDD. Participants who screened positive on the AHA depression protocol had a 55% greater risk of events than those who screened negative (age-adjusted HR 1.55, 95% CI 1.21-1.97; p=0.0005). After adjustment for sex, body mass index, history of myocardial infarction, hypertension, diabetes, heart failure and HDL levels, screening positive remained associated with a 41% greater rate of cardiovascular events (HR 1.41, 95% CI, 1.10-1.81; p=0.008). Conclusions- Among outpatients with stable CHD, the AHA-recommended depression screening protocol is highly specific for depression and identifies patients at risk for adverse cardiovascular outcomes.