Title: An integrated approach to cardiovascular disease in homeless individuals-unmet needs in epidemiology, risk prediction and management
Funder: Department of Health and Social Care

Abstract: Our research aims to characterise the burden of cardiovascular disease(CVD), including heart disease and strokes, in homeless individuals in the UK. In addition, we will develop new tools and pathways of care to integrate CVD care in current healthcare provision for homeless populations, whilst comparing the effectiveness and cost-effectiveness of different models of CVD care. CVD is the largest burden of disease in the NHS and there have been great advances in the last forty years in both treatment and prevention. However, CVD is neglected in homeless populations within emphasis on infectious diseases and acute crisis management, despite being the commonest cause of death in homeless individuals. Moreover, recent policy initiatives to tackle CVD fail to mention homeless populations, despite previous research suggesting five-fold increased risk of coronary artery disease and stroke, compared with housed people living in the most socially deprived areas. Research regarding disease burden and care pathways is needed to improve healthcare for a needy disease in a needy population. In a 12-month programme development project, we will conduct preliminary work in three areas to inform a more extensive research study: (i) pathways; (ii) electronic health records; and (iii) CVD screening in an existing care pathway for homeless populations in London. First, we will conduct a literature review about CVD and its management in homeless populations. Two focus groups involving homeless populations, public and care providers will consider CVD care for homeless people. We will estimate use of health services by homeless patients over a 6-month period at UCL Partners and Barts Health for coronary disease and heart failure. Second, we will estimate burden of coronary disease and heart failure in homeless individuals using electronic health records from GPs nationally and in East London and from the Find&Treat service, an existing pathway at UCL Hospital for homeless patients. Third, over a 6-month period, we will introduce screening for CVD in the Find&Treat service, focusing on atrial fibrillation(the commonest heart rhythm disorder, which increases risk of stroke), peripheral arterial disease and hypertension, and measure use of health services to treat these conditions. Homeless individuals and public have been involved in identifying CVD as an important area for research and developing health services. In previous public engagement work and in the focus groups in this work, they will inform the design of our research to improve CVD care for homeless populations. By having stakeholders in our investigator team, we will ensure that this engagement continues during the research and when further work is planned. Our results will be disseminated via a study website, and our research and NHS networks. By consultation with stakeholders, we will ensure that results are publicised in inclusion health networks and homeless populations.

Lay abstract: Our research aims to characterise the burden of cardiovascular disease(CVD), including heart disease and strokes, in homeless individuals in the UK. In addition, we will develop new tools and pathways of care to integrate CVD care in current healthcare provision for homeless populations, whilst comparing the effectiveness and cost-effectiveness of different models of CVD care. CVD is the largest burden of disease in the NHS and there have been great advances in the last forty years in both treatment and prevention. However, CVD is neglected in homeless populations within emphasis on infectious diseases and acute crisis management, despite being the commonest cause of death in homeless individuals. Moreover, recent policy initiatives to tackle CVD fail to mention homeless populations, despite previous research suggesting five-fold increased risk of coronary artery disease and stroke, compared with housed people living in the most socially deprived areas. Research regarding disease burden and care pathways is needed to improve healthcare for a needy disease in a needy population. In a 12-month programme development project, we will conduct preliminary work in three areas to inform a more extensive research study: (i) pathways; (ii) electronic health records; and (iii) CVD screening in an existing care pathway for homeless populations in London. First, we will conduct a literature review about CVD and its management in homeless populations. Two focus groups involving homeless populations, public and care providers will consider CVD care for homeless people. We will estimate use of health services by homeless patients over a 6-month period at UCL Partners and Barts Health for coronary disease and heart failure. Second, we will estimate burden of coronary disease and heart failure in homeless individuals using electronic health records from GPs nationally and in East London and from the Find&Treat service, an existing pathway at UCL Hospital for homeless patients. Third, over a 6-month period, we will introduce screening for CVD in the Find&Treat service, focusing on atrial fibrillation(the commonest heart rhythm disorder, which increases risk of stroke), peripheral arterial disease and hypertension, and measure use of health services to treat these conditions. Homeless individuals and public have been involved in identifying CVD as an important area for research and developing health services. In previous public engagement work and in the focus groups in this work, they will inform the design of our research to improve CVD care for homeless populations. By having stakeholders in our investigator team, we will ensure that this engagement continues during the research and when further work is planned. Our results will be disseminated via a study website, and our research and NHS networks. By consultation with stakeholders, we will ensure that results are publicised in inclusion health networks and homeless populations.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR;STROKE