• Kyoung Suk Lee, Debra K Moser, Michele Pelter, Martha J Biddle, and Kathleen Dracup.
• Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dea Jeon, South Korea. Debra K. Moser is a professor and holds the Linda C. Gill Endowed Chair of Nursing, and Martha J. Biddle is an assistant professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Michele Pelter is an assistant professor, and Kathleen Dracup is a professor and dean emeritus, School of Nursing, University of California, San Francisco, San Francisco, California. kslee14@cnu.ac.kr.
• Am. J. Crit. Care. 2017 May 1; 26 (3): 240-247.

BackgroundComorbid depression in patients with heart failure is associated with increased risk for death. In order to effectively identify depressed patients with cardiac disease, the American Heart Association suggests a 2-step screening method: administering the 2-item Patient Health Questionnaire first and then the 9-item Patient Health Questionnaire. However, whether the 2-step method is better for predicting poor prognosis in heart failure than is either the 2-item or the 9-item tool alone is not known.ObjectiveTo determine whether the 2-step method is better than either the 2-item or the 9-item questionnaire alone for predicting all-cause mortality in heart failure.MethodsDuring a 2-year period, 562 patients with heart failure were assessed for depression by using the 2-step method. With the 2-step method, results are considered positive if patients endorse either depressed mood or anhedonia on the 2-item screen and have scores of 10 or higher on the 9-item screen.ResultsScreening results with the 2-step method were not associated with all-cause mortality. Patients with scores positive for depression on either the 2-item or 9-item screen alone had 53% and 60% greater risk, respectively, for all-cause death than did patients with scores negative for depression after adjustments for covariates (hazard ratio, 1.530; 95% CI, 1.029-2.274 for the 2-item screen; hazard ratio, 1.603; 95% CI, 1.079-2.383 for the 9-item screen).ConclusionsThe 2-step method has no clear advantages compared with the 2-item screen alone or the 9-item screen alone for predicting adverse prognostic effects of depressive symptoms in heart failure.©2017 American Association of Critical-Care Nurses.

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