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.

Keywords: Depression; Patient Health Questionnaire; heart failure; mortality; screening.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Fig. 1

Study recruitment and 4-year follow-up. Abbreviations: PHQ-2, two-item Patient Health Questionnaire; PHQ-9, nine-item Patient Health Questionnaire. †We targeted recruitment of 372 PHQ-2 (+) patients and purposely oversampled PHQ-2 (+) patients by concluding recruitment of PHQ-2 (−) patients after we reached our planned goal of 100 patients.

Fig. 2

4-Year all-cause and cardiovascular mortality by baseline PHQ status. (A) All-cause mortality by PHQ-2 status. By 4-year follow-up, 44% of PHQ-2 (+) and 38% of PHQ-2 (−) patients had died (P=.16). (B) Cardiovascular mortality by PHQ-2 status. By 4-year follow-up, 29% of PHQ-2 (+) and 27% of PHQ-2 (−) patients had died of a cardiovascular cause (P=.44). (C) All-cause mortality by baseline PHQ-9 level among 371 PHQ-2 (+) patients. By 4-year follow-up, 44%, 50% and 37% of HF patients with PHQ-9 score levels 0–9, 10–14 and ≥15, respectively had died (P=.17). Abbreviations: PHQ-2 (+), positive Patient Health Qustionnaire-2 screen for depression; PHQ-2 (−), negative Patient Health Qustionnaire-2 screen for depression.