Effect of a housing intervention on major cardiovascular events among homeless adults with mental illness

ABSTRACT

Homelessness is associated with excess cardiovascular morbidity and mortality. This study reports on the long-term effects of a Canadian housing first initiative, compared to treatment as usual, on major cardiovascular events among adults experiencing homelessness and mental illness. Over the 7-year follow-up period, 34 of 527 participants (6.5%) experienced at least one cardiovascular event. There was no significant difference in the incidence of cardiac events between the housing first and treatment as usual groups. Strengths of this study include its randomized controlled design and use of comprehensive administrative databases to ascertain cardiac events. However, a relatively small sample size limited power to determine whether housing reduced the incidence of major adverse cardiovascular events. Notwithstanding these limitations, additional interventions aimed at improving cardiovascular outcomes are likely to be beneficial for patients undergoing a housing intervention.

Trial registration: ISRCTN.org identifier: ISRCTN42520374.

KEYWORDS:

• Cardiovascular disease
• cardiac events
• homeless
• housing
• health services research

Acknowledgments

The Toronto site of the AH/CS study was funded by the Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care (HSRF 259), and the Canadian Institutes of Health Research (MOP-130405 and FDN-167263). This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The funders had no role in the analysis and interpretation of the data or the preparation, review, and approval of the manuscript. The views expressed in this publication are the views of the authors and do not necessarily reflect those of the funders.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Canadian Institutes of Health Research: [Grant Number MOP-130405 and FDN-167263]; Ontario Ministry of Health and Long-Term Care: [Grant Number HSRF 259].

Notes on contributors

Samantha S. L. Liauw

Samantha S. L. Liauw is a cardiologist and clinical fellow in interventional cardiology at the University of Toronto.

Cilia Mejia-Lancheros

Cilia Mejia-Lancheros is a post-doctoral fellow at the MAP Centre for Urban Health Solutions, Unity Health Toronto.

James Lachaud

James Lachaud is a postdoctoral fellow at the MAP Centre for Urban Health Solutions, Unity Health Toronto.

Patricia O’Campo

Patricia O'Campo is a Professor in the Dalla Lana School of Public Health at the University of Toronto and a research scientist at the MAP Centre for Urban Health Solutions, Unity Health Toronto.

Vicky Stergiopoulos

Vicky Stergiopoulos is a Clinician Scientist and the Physician-in-Chief at the Centre for Addiction and Mental Health, and a Professor in the Department of Psychiatry at the University of Toronto.

Stephen W. Hwang

Stephen W. Hwang is a Professor of Medicine at the University of Toronto and Director of the MAP Centre for Urban Health Solutions, Unity Health Toronto.