Screening of depression in cardiology: A study on 617 cardiovascular patients

Background: Depression screening in the cardiovascular disease (CVD) care setting is under-performed, also be- cause the issue of the optimal screening tools cut-off is still open. We analysed which HADS (Hospital Anxiety and Depression Scale) total score cut-off value shows the best properties in two groups of 357 Acute Coronary Syndrome (ACS) and 260 Chronic Coronary Artery Disease (CAD) hospitalized patients. Methods: A Receiver Operating Characteristics (ROC) curve was plotted for both groups using the Montgomery- Asberg Depression Rating Scale (MADRS) as the criterion. Accuracy, positive (PPV) and negative (NPV) predictive values were computed for different cut-off scores. Results: The ROC curves confirmed the excellent/very good accuracy of the HADS in both groups, with an area under the curve of 0.911 for the ACS and 0.893 for the CAD patients. The cut-off of 14 showed the best compro- mise between high sensitivity and good specificity in both groups, with high negative predicted values (95.5% and 92.4%, respectively). Conclusion: Using a cut-off value of 14, the HADS could be considered a good screening tool to identify hospital- ized CAD and ACS patients requiring a more accurate depression assessment, in order to promptly plan the most appropriate treatment strategies and prevent the negative effects of depression in CVD patients.