BACKGROUND
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.
METHODS AND RESULTS
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.
CONCLUSION
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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© 2021 Published by Elsevier Inc.
