The prognostic impact and optimal timing of the Patient Health Questionnaire depression screen on 4-year mortality among hospitalized patients with systolic heart failure

Abstract

Objective An American Heart Association (AHA) Science Advisory recommends patients with coronary heart disease undergo routine screening for depressive symptoms with the two-stage Patient Health Questionnaire (PHQ). However, little is known on the prognostic impact of a positive PHQ screen on heart failure (HF) mortality. Methods We screened hospitalized patients with systolic HF (left ventricle ejection fraction≤40%) for depression with the two-item Patient Health Questionnaire (PHQ-2) and administered the follow-up nine-item Patient Health Questionnaire (PHQ-9) both immediately following the PHQ-2 and by telephone 1 month after discharge. Later, we ascertained vital status at 4-year follow-up on all patients who completed the inpatient PHQ-9 and calculated mortality incidence and risk by baseline PHQ. Results Of the 520 HF patients, we enrolled 371 screened positive for depressive symptoms on the PHQ-2. Of these, 63% scored PHQ-9≥10 versus 24% of those who completed the PHQ-9 1 month later (P<.001). PHQ-2 positive status was an independent predictor of 4-year all-cause mortality (HR: 1.50; P=.04), and mortality incidence was similar by baseline PHQ-9 score. Conclusions Among hospitalized patients with systolic HF, a positive PHQ-2 screen for depressive symptoms is an independent risk factor for increased 4-year all-cause mortality. Our findings extend the AHA's Science Advisory for depression to hospitalized patients with systolic HF.

Affective and cognitive rather than somatic symptoms of depression predict 3-year mortality in patients on chronic hemodialysis

“…Depression is a mood disorder with a prevalence in the general population ranging from 1.6% in China 1 to 5.0% in the United Kingdom 2 and 9.0% in the United States 3 . Depression is even more common in patients with certain organic illnesses, such as congestive heart failure (63%) 4 , malignancy (20.7%) 5 and diabetes (20–25%) 6 . Coexistence of the diseases with depression is associated with many adverse outcomes, including increased mortality 4 , 6 , 7 .…”

Screening for symptomer på depresjon og angst ved en hjertemedisinsk avdeling

“…American Heart Association (7) og Helsedirektoratet (15) anbefaler bruk av to screeningspørsmål for symptomer på depresjon, Patient Health Questionnaire-2 (PHQ-2). Spørsmålene er vist å vaere en uavhengig prediktor for dødelighet ved hjertesvikt opp til fire år etter innleggelse (18). NICE anbefaler bruk av to spørsmål om angstsymptomer som screening, Generalized Anxiety Disorder Scale-2 (GAD-2) (19).…”

Positive Psychological well-being and Health in Patients With Heart Disease: A Brief Review

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