Improving Depression Assessment & Management in Heart Failure Patients at the Pali Momi Medical Center

Abstract

Background/Purpose: Heart failure (HF) is an increasingly prevalent disease and a major cause of morbidity and mortality around the world. Depression is more common in people with HF than in the general population however, it is under-diagnosed and under-treated. The purpose of this project was to implement a depression assessment program to improve staff knowledge about evidence-based depression screening and management guidelines, as well as increase the number of patients screened for depression in an outpatient cardiology setting. Method and Results: Providers and staff participated in an educational presentation that covered various topics including depression incidence in HF patients, evaluating depression in the primary care setting, interpretation of the PHQ-9 score, and depression screening guidelines & recommendations. A pre- and post-test was used to measure if there was an improvement in staff knowledge after the educational intervention. The total staff knowledge rating of the pre-test showed a mean score of 5.9 and post-test score of 8.1. Changes from pre-test to post-test were assessed using a paired samples t-test which showed the results to be significant: t(9) = -2.39, p<.01. The t-value was then converted to a correlation to assess strength of effect. Results indicated a large effect size (i.e., >.50) with an r = .62. During the PHQ-9 pilot period, the depression assessment was administered to HF patients. The patient’s PHQ-9 score was shared with the cardiologist for further evaluation and management. The number of completed PHQ-9 surveys were tracked at weekly intervals. Of the 87 patients who completed the PHQ-9 survey, the average score was 2.94. 61.7% of patients scored 0 to 4 (no depression), 9.3% scored 5 to 9 (mild depression), 9.3% scored between 10 to 14 (moderate depression), less than 1% scored between 15 to 19 (moderate-severe depression), and 0% of patients scored greater than 20 (severe depression). 2 patients were referred to the psychologist for further evaluation. Discussion: Depression is under-recognized and under-treated in the HF population due to a lack of systematic assessment. Administering depression screenings in a cardiology outpatient setting affords a rich opportunity for identifying and managing patients at risk for psychosocial issues. Although our findings suggest a low prevalence of depression in the HF population, this project supports the continued use of the PHQ-9 survey as a cost-saving measure to enhance patient care. Additional implications included raising awareness on depression and the benefits of an EBP project.