Assess and Address: Screening and Management for Depression in Patients with Chronic Heart Failure

Background: Depression is two to three times more likely in patients with heart failure (HF) than in the general population. Comorbid HF and depression are associated with poor outcomes and increased healthcare burden. Clinical guidelines from professional organizations recommend routine depression screening in patients with HF. However, screening is not systematically implemented in outpatient cardiology settings. Objective: The objective of this process improvement project was to create a sustainable process for an outpatient cardiology clinic to screen adults with chronic HF for depression, to identify patients who have an elevated depression screening score, and to initiate an evidence-based treatment algorithm for patients evaluated as having elevated screening scores due to depression. Methods: A nurse practitioner-led process improvement project, set in an outpatient cardiology clinic, administered the Patient Health Questionnaire (PHQ-9) tool to patients who presented to the clinic for HF care. The score was reviewed by the provider and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated PHQ-9 score addressed with a documented treatment plan by the provider.Results: Post-implementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, for an overall of 61.9% of patients screened during the project. Twenty-one unique patients (13.17%) had elevated PHQ-9 scores; all of whom had a documented assessment and treatment plan. Conclusions: We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record that supported the screening tool used, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.Doctor of Nursing Practic