期刊
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
卷 4, 期 5, 页码 533-540出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCOUTCOMES.110.960302
关键词
cardiovascular diseases; diagnosis; prognosis; psychiatric comorbidity; risk factors
资金
- UCSF School of Medicine
- University of California, San Francisco
- Department of Veterans Affairs, the National Heart, Lung, and Blood Institute [R01 HL079235]
- American Federation for Aging Research
- Robert Wood Johnson Foundation
- Ischemia Research and Education Foundation
- American Heart Association Pharmaceutical Roundtable
- David and Stevie Spina [0875149N]
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, 0.4 6 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. (Circ Cardiovasc Qual Outcomes. 2011;4:533-540.)
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