Canadian Journal of Cardiology



      People experiencing homelessness experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality compared to housed individuals. This is due to complex, intersecting risk factors, comorbidities, and socioeconomic factors, including an unstable living environment, lack of access to healthcare, and past discriminatory healthcare experiences, among others. However, relatively little is known about how this marginalized population currently manages their disease, and what programs or care pathways have been developed to address their unique needs. The objective of this work was to explore the perspectives and experiences of people experiencing homelessness and CVD, as well as understand the care management programs, interventions, and processes developed for them.


      We conducted a systematic scoping review guided by Arksey and O'Malley methods. A comprehensive search was completed in 6 databases (MEDLINE, Embase, Web of Science, CINAHL, PsychInfo, Proquest) and grey literature by 2 reviewers, using keywords related to CVD, homelessness, and program/management. We used a conventional content analysis to complete a narrative synthesis. We identified a total of 29 articles that met inclusion criteria. The majority of work was conducted in the USA and included a variety of qualitative and quantitative methods. Limited, small scale program pilots, such as mobile clinics in homeless shelters or case management processes, have been developed. Importantly, no interventions have been developed specifically for CVD management in people experiencing homelessness. We capture these learnings and recommendations in the following way: program category (prevention, diagnosis management), general program principles/goals, program multi-disciplinary players, program elements, and program outcomes.


      There is an urgent need to tailor CVD management pathways and programs for people experiencing homelessness to meet them where they are at. Multi-disciplinary collaboration and engagement with people with lived experience are imperative to their development. Studies that evaluate the feasibility and scalability of existing pilot programs are a realistic first step.
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