CV mortality major cause of death among homeless adults

CV mortality persists as a leading cause of death among the U.S. homeless population, likely due to challenges in predicting initial risk, limited access to health care and difficulties in long-term management, according to a review published in the Journal of the American College of Cardiology.

“Clinicians need to make a concerted effort to overcome the logistical hurdles to treating and preventing cardiovascular disease in homeless populations,” Stephen W. Hwang, MD, MPH, director of the Centre for Urban Health Solutions of St. Michael’s Hospital in Toronto, said in a press release. “Half of homeless individuals don’t have access to a consistent source of health care, making follow-up visits and lengthy diagnostic tests a challenge. It’s our duty as health care providers to adjust our practices to provide the best possible care for these vulnerable patients.”

Although the definition of homeless is constantly evolving and changing, approximately 550,000 people in the United States are homeless on any given night, and an estimated 2.3 million to 3.5 million people experience homelessness during a year, the authors wrote.

Proper prevention, treatment

The median age of the homeless population is 50 years, approximately 60% are men and 39% are black adults. It is known that patients in these demographic groups are prone to higher than average CVD mortality rates, highlighting the need for proper prevention and treatment.

Although the prevalence of hypertension and diabetes among homeless individuals is similar to that of the general population, it often goes untreated, leading to worse BP and blood glucose control. The researchers found that smoking remains the largest contributor to CVD mortality in homeless populations, accounting for 60% of ischemic heart disease deaths in this population.

The researchers also found that most homeless individuals have a desire to quit smoking, but their quit rates are only one-fifth the national average.

The review from Hwang and colleagues notes that none of the current CVD risk prediction models used in clinical practice have been confirmed in homeless populations, which could be the leading cause of knowledge gaps for the treatment of nontraditional CVD risk factors.

According to the authors, the likelihood of ED utilization was higher among homeless patients, but without health insurance and permanent housing, homeless patients struggle to adhere to medication that requires multiple doses per day.

Recent studies show 44% to 89% of homeless individuals have cellphones, so appointment reminders delivered via text message may enhance follow-up visits, Hwang and colleagues wrote.

Numerous barriers

Limited access to care, adherence to medication and commitment to evidence-based treatment all contribute to the difficulty in treating this patient set, they wrote.

According to the researchers, when a diagnosis of CVD is confirmed in a homeless patient, they should consult with a cardiologist for next steps in the management process and schedule regular follow-up with patients to minimize the risk of loss of care. Practical, patient-centered care can ultimately deliver optimal CV outcomes, according to the study.

“We need to apply evidence-based treatment guidelines for patients experiencing homelessness, and cardiologists can work with primary care providers to help achieve this goal,” Hwang said in the release. – by Dave Quaile

Disclosures: Hwang reports no relevant financial disclosures. Another author reports he receives royalty payments from UpToDate.