Cardiovascular disease screening in homeless individuals: A feasibility study.


Author: Julian Surey, Martha Veitch, Nader Al-Shakarchi, Sally Rogers, Stan Burridge, Mark Leonard, Alistair Story, Amitava Banerjee

Theme: Models of Care Year: 2023

Background:
The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals, yet population-level CVD screening largely excludes homeless individuals. This pilot aimed to investigate the feasibility of dedicated mobile CVD screening for homeless individuals and estimate the prevalence of risk factors and burden of CVD.

Description of model of care/intervention:
Peers, health professionals and researchers co-developed and implemented a 15-minute CVD assessment alongside Find&Treat (a peer-led, multi-disciplinary outreach team working across London) during routine visits to emergency homeless accommodations. This included a questionnaire (demographic, medical history and symptom data) and clinical assessment (blood pressure, ABPI, cholesterol, HDL, HDL ratio, glucose, HbA1c and mobile ECG to detect atrial fibrillation, AF).

Effectiveness:
524 individuals were screened in 75 routine visits (May 2019-January 2023). Mean age was 47 years. Male gender (79%) and white ethnicity (55%) were more common. Current or previous smoking (79%), previous CVD (15%) and family history of heart attack in a 1st degree relative<60 years (27%) were common.

Only 2% reported previous diagnosis of high cholesterol but upon screening, 24% had total cholesterol>5.0 mmol/L. Prevalence of AF was high, particularly among those aged 18-30 (12%). Asian/British Asian individuals had highest prevalence of raised HbA1C levels (>6%) (24%), compared to black/black British (18%) and white (5%) individuals. Among those aged 25-84 with no previous CVD, one third had ≥10% risk of developing a heart attack or stroke over the next 10 years (33%), consistent across different ethnic groups: white (32%), black (31%) and Asian (35.3%).

Conclusions and next steps:
A simple CVD assessment for homeless individuals was feasible and identified gaps in diagnosis. There is a high burden of CVD risk factors and CVD amongst homeless individuals, which could be addressed by integration of CVD screening into existing inclusion health outreach frameworks. 

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