Implementation and evaluation of depression screening in patients with recently diagnosed coronary artery disease

Abstract

Introduction Patients with coronary artery disease (CAD) are at an increased risk for depression. Additionally, comorbid depression in patients with CAD is associated with increased mortality and worse cardiac outcomes. Screening this patient population for depression is recommended but is not routinely done in practice. The purpose of this quality improvement initiative was to implement a protocol to screen patients with CAD for depression using the Patient Health Questionnaire (PHQ-9). Primary objectives were to determine the frequency of positive depression screens and the frequency of acceptance of mental health (MH) service referral. Methods Patients with CAD were screened for depression using the PHQ-9 during a hospital admission to the inpatient cardiology unit at the Clement J. Zablocki Veterans Affairs Medical Center. All patients were rescreened for depression at 4 and 8 weeks after discharge. Patients with positive screens for depression were offered referral for MH services, and reasons for decline were documented. Results Of the 36 patients screened for depression, 14 (39%) screened positive for depression, including 10 patients at baseline (28%), 3 additional patients (8%) at week 4 after discharge, and 1 additional patient (3%) at week 8 after discharge. Of the 14 patients who screened positive for depression, 3 patients (21%) accepted MH service referral. The most commonly reported reason for declining referral was no perceived benefit. Discussion The results of this initiative support the utility of using the PHQ-9 for depression screening in patients with recently diagnosed CAD and offering MH service referral for treatment of comorbid depression.

Age and Marital Status Predict Mild Cognitive Impairment During Acute Coronary Syndrome Admission

“…A cutoff score of ≥10 has demonstrated an 88% sensitivity and an 88% specificity in major depressive disorders in a general population 29 . However, the PHQ9 is susceptible to false negatives using a cutoff of ≥10 in populations with coronary heart disease, having demonstrated a specificity of 91% and a sensitivity of 52% in validation studies 30 . Hence, a threshold of ≥5 is recommended 30 and was therefore used for this study for classifying mild or more depressive symptoms.…”