BACKGROUND: The American Heart Association (AHA) statement has recommended 
routine screening for depression in coronary artery disease with a 2-stage 
implementation of the Patient Health Questionnaire (PHQ). Because there is 
little evidence on feasibility, accuracy, and impact of such a program on 
depression recognition in coronary patients, the AHA recommendation has met 
substantial debate and criticism.
METHODS AND RESULTS: Before the AHA statement was released, the Mid America 
Heart and Vascular Institute (MAHVI) had implemented a depression screening 
protocol for patients with acute myocardial infarction that was virtually 
identical to the AHA recommendations. To (1) evaluate this MAHVI quality 
improvement initiative, (2) compare MAHVI depression recognition rates with 
those of other hospitals, and (3) examine health care providers' implementation 
feedback, we compared the results of the MAHVI screening program with data from 
a parallel prospective acute myocardial infarction registry and interviewed 
MAHVI providers. Depressive symptoms (PHQ-2, PHQ-9) were assessed among 503 
MAHVI acute myocardial infarction patients and compared with concurrent 
depression assessments among 3533 patients at 23 US centers without a screening 
protocol. A qualitative summary of providers' suggestions for improvement was 
also generated. A total of 135 (26.8%) eligible MAHVI patients did not get 
screened. Among screened patients, 90.9% depressed (PHQ-9 ≥10) patients were 
recognized. The agreement between the screening and registry data using the full 
PHQ-9 was 61.5% for positive cases (PHQ-9 ≥10) but only 35.6% for the PHQ-2 
alone. Although MAHVI had a slightly higher overall depression recognition rate 
(38.3%) than other centers not using a depression screening protocol (31.5%), 
the difference was not statistically significant (P=0.31). Staff feedback 
suggested that a single-stage screening protocol with continuous feedback could 
improve compliance.
CONCLUSIONS: In this early effort to implement a depression screening protocol, 
a large proportion of patients did not get screened, and only a modest impact on 
depression recognition rates was realized. Simplifying the protocol by using the 
PHQ-9 alone and providing more support and feedback may improve the rates of 
depression detection and treatment.