Author + information
- Received September 1, 2017
- Revision received February 9, 2018
- Accepted February 11, 2018
- Published online May 28, 2018.
- Travis P. Baggett, MD, MPHa,b,c,
- Samantha S. Liauw, MDd and
- Stephen W. Hwang, MD, MPHd,e,∗ (, )@StephenHwang
- aDivision of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
- bDepartment of Medicine, Harvard Medical School, Boston, Massachusetts
- cInstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
- dDivision of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- eCentre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Stephen Hwang, Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
Dr. Baggett has received royalty payments for authorship of topic review on homeless health care from UpToDate. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 1, 2017.
- Revision received February 9, 2018.
- Accepted February 11, 2018.
- 2018 American College of Cardiology Foundation
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