{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:52:13Z","timestamp":1782323533247,"version":"3.54.5"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"TRANSFORM HF\u2019s","award":["Collaboration Starter Grants"],"award-info":[{"award-number":["Collaboration Starter Grants"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart failure (HF) is a major global public health challenge and a leading cause of morbidity and mortality, particularly among older adults. The rising prevalence of HF is driven by aging populations and the increasing burden of chronic conditions such as hypertension, diabetes, and obesity. In Canada alone, over 750,000 individuals live with HF, with over 100,000 new cases diagnosed annually. Despite advancements in pharmacological and device-based treatments, HF remains a primary cause of hospital admissions, with readmission rates exceeding 20% within 30 days. The associated healthcare costs are projected to reach $2.8 billion annually by 2030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Older adults experiencing homelessness represent a particularly vulnerable population at risk for HF. Homelessness is associated with increased exposure to cardiovascular risk factors, including inadequate access to preventive healthcare, high rates of comorbid conditions, and environmental stressors. Evidence suggests that individuals experiencing homelessness have a significantly higher incidence and earlier onset of HF compared to the general population, yet this intersection remains underexplored in the literature. This paper outlines the protocol for a systematic review and meta-analysis that aims to address this gap by synthesizing the prevalence, incidence, and mortality of HF among older adults who have experienced homelessness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review will follow the PRISMA and MOOSE guidelines and has been registered on the Open Science Framework. We will include studies examining the prevalence, incidence, or mortality of HF among older adults (aged 50 and above) with a history of homelessness. The decision to lower the age threshold to 50 reflects the accelerated aging process observed in this population, who often experience age-related conditions at a younger chronological age. Eligible study designs include cross-sectional, cohort, and case-control studies. Quantitative data from peer-reviewed publications and grey literature will be included, with no language or date restrictions. A comprehensive search strategy will be applied across major electronic databases, including Medline, Embase, Cochrane Library, and ISI Web of Science. We will also perform grey literature searches through Google Scholar and governmental websites. Backward citation tracking will be conducted to identify additional relevant studies. Study selection will involve independent screening by three reviewers, with disagreements resolved by consensus. Data extraction will include study characteristics, participant demographics, and HF-related outcomes. Risk of bias will be assessed using the Joanna Briggs Institute Checklist for Prevalence Studies and the ROBINS-E tool for non-randomized studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The review will estimate pooled prevalence, incidence, and mortality rates of HF in older adults experiencing homelessness. Where possible, we will conduct subgroup analyses based on age, sex, and comorbidities. Meta-regression and sensitivity analyses will be performed to assess the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis will provide the first comprehensive synthesis of HF epidemiology in older adults experiencing homelessness. By identifying disparities in cardiovascular health outcomes, this study aims to inform public health policies, healthcare delivery, and future research to improve cardiovascular care for this marginalized population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345868","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:33:41Z","timestamp":1782322421000},"page":"e0345868","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of heart failure and coronary artery disease in older adults experiencing homelessness: A systematic review and meta-analysis protocol with a consultative exercise"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1277-472X","authenticated-orcid":true,"given":"Kristina M.","family":"Kokorelias","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1006-5118","authenticated-orcid":true,"given":"Yu Qing","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6889-3015","authenticated-orcid":true,"given":"Maurita T.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Hoang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"1","key":"pone.0345868.ref001","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1023\/A:1013793621248","article-title":"The burden of chronic congestive heart failure in older persons: magnitude and implications for policy and research","volume":"7","author":"FA Masoudi","year":"2002","journal-title":"Heart Fail Rev"},{"issue":"22","key":"pone.0345868.ref002","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1016\/j.jacc.2018.02.077","article-title":"Cardiovascular disease and homelessness","volume":"71","author":"TP Baggett","year":"2018","journal-title":"Journal of the American College of Cardiology"},{"issue":"1","key":"pone.0345868.ref003","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1186\/s12913-024-11503-0","article-title":"Cardiovascular disease management and healthcare delivery for people experiencing homelessness: a scoping review","volume":"24","author":"J Macklin","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0345868.ref004","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1353\/hpu.2021.0153","article-title":"Health Status and Chronic Disease Burden of the Homeless Population: An Analysis of Two Decades of Multi-Institutional Electronic Medical Records","volume":"32","author":"WP Bensken","year":"2021","journal-title":"J Health Care Poor Underserved"},{"issue":"17","key":"pone.0345868.ref005","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: a comprehensive and updated review of epidemiology","volume":"118","author":"G Savarese","year":"2023","journal-title":"Cardiovasc Res"},{"issue":"7","key":"pone.0345868.ref006","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3390\/jcm5070062","article-title":"Heart Failure: Diagnosis, Management and Utilization","volume":"5","author":"AA Inamdar","year":"2016","journal-title":"J Clin Med"},{"issue":"1","key":"pone.0345868.ref007","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40900-023-00412-x","article-title":"Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period","volume":"9","author":"J Butler","year":"2023","journal-title":"Res Involv Engagem"},{"issue":"12","key":"pone.0345868.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0189938","article-title":"Mortality among the homeless: Causes and meteorological relationships","volume":"12","author":"J Romaszko","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pone.0345868.ref009","first-page":"23","article-title":"An intelligent system approach for predicting the risk of heart failure","volume":"76","author":"IRK IRK","year":"2024","journal-title":"Engineering Proceedings"},{"issue":"2","key":"pone.0345868.ref010","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1002\/ehf2.13221","article-title":"Hospital readmissions of patients with heart failure from real world: timing and associated risk factors","volume":"8","author":"M Wideqvist","year":"2021","journal-title":"ESC Heart Fail"},{"issue":"3","key":"pone.0345868.ref011","article-title":"The current and future financial burden of hospital admissions for heart failure in Canada: a cost analysis","volume":"4","author":"DT Tran","year":"2016","journal-title":"CMAJ Open"},{"key":"pone.0345868.ref012","author":"BI Patel","year":"2013"},{"issue":"3","key":"pone.0345868.ref013","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1001\/jamainternmed.2019.6010","article-title":"Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions","volume":"180","author":"RK Wadhera","year":"2020","journal-title":"JAMA Intern Med"},{"key":"pone.0345868.ref014","doi-asserted-by":"crossref","first-page":"1061190","DOI":"10.3389\/fmed.2023.1061190","article-title":"The impact of persistent precarity on patients\u2019 capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa","volume":"10","author":"M van Pinxteren","year":"2023","journal-title":"Front Med (Lausanne)"},{"issue":"25","key":"pone.0345868.ref015","first-page":"423","article-title":"Improving treatment adherence in heart failure: a systematic review and meta-analysis of pharmacological and lifestyle interventions","volume":"113","author":"S Unverzagt","year":"2016","journal-title":"Deutsches \u00c4rzteblatt International"},{"key":"pone.0345868.ref016","unstructured":"Soucy D, Janes M, Hall A. State of Homelessness: 2024 Edition. 2024. https:\/\/endhomelessness.org\/state-of-homelessness\/"},{"issue":"1","key":"pone.0345868.ref017","article-title":"Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction","volume":"10","author":"H Burnett","year":"2017","journal-title":"Circ: Heart Failure"},{"issue":"4","key":"pone.0345868.ref018","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2017.12.013","article-title":"Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs","volume":"19","author":"M de Vries","year":"2018","journal-title":"J Am Med Dir Assoc"},{"issue":"3","key":"pone.0345868.ref019","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jamda.2016.11.025","article-title":"The Association of Potentially Inappropriate Medication at Older Age With Cardiovascular Events and Overall Mortality: A Systematic Review and Meta-Analysis of Cohort Studies","volume":"18","author":"DC Muhlack","year":"2017","journal-title":"J Am Med Dir Assoc"},{"issue":"22","key":"pone.0345868.ref020","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1016\/j.jacc.2020.09.606","article-title":"Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review","volume":"76","author":"A Krishnaswami","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"pone.0345868.ref021","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.jacc.2021.06.040","article-title":"Device therapy in chronic heart failure: JACC state-of-the-art review","volume":"78","author":"M Fudim","year":"2021","journal-title":"J American College of Cardiology"},{"issue":"5","key":"pone.0345868.ref022","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s10741-023-10311-8","article-title":"Aerobic and resistance exercise in heart failure inpatients: a scoping review","volume":"28","author":"I Lopes","year":"2023","journal-title":"Heart Fail Rev"},{"key":"pone.0345868.ref023","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.2147\/TCRM.S350748","article-title":"Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review","volume":"18","author":"D Tsukakoshi","year":"2022","journal-title":"Ther Clin Risk Manag"},{"issue":"8","key":"pone.0345868.ref024","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1001\/jamasurg.2021.0546","article-title":"PRISMA Reporting Guidelines for Meta-analyses and Systematic Reviews","volume":"156","author":"S Arya","year":"2021","journal-title":"JAMA Surg"},{"issue":"15","key":"pone.0345868.ref025","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"DF Stroup","year":"2000","journal-title":"JAMA"},{"issue":"8","key":"pone.0345868.ref026","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1111\/jan.15265","article-title":"Arksey and O\u2019Malley\u2019s consultation exercise in scoping reviews: A critical review","volume":"78","author":"N Buus","year":"2022","journal-title":"J Adv Nurs"},{"issue":"9","key":"pone.0345868.ref027","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.jpain.2017.03.011","article-title":"Characteristics and Factors Associated With Pain in Older Homeless Individuals: Results From the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) Study","volume":"18","author":"JC Landefeld","year":"2017","journal-title":"J Pain"},{"issue":"4","key":"pone.0345868.ref028","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/j.1839-4655.1992.tb00911.x","article-title":"Understanding Contemporary Homelessness: Issues of Definition and Meaning","volume":"27","author":"C Chamberlain","year":"1992","journal-title":"Aust J Social Issues"},{"key":"pone.0345868.ref029","doi-asserted-by":"crossref","first-page":"1086215","DOI":"10.3389\/fpubh.2023.1086215","article-title":"Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants","volume":"11","author":"R Mantell","year":"2023","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0345868.ref030","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/j.1365-2753.2008.00954.x","article-title":"Diagnostic accuracy of clinical criteria for identifying systolic and diastolic heart failure: cross-sectional study","volume":"15","author":"A Maestre","year":"2009","journal-title":"J Eval Clin Pract"},{"key":"pone.0345868.ref031","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-078384","article-title":"Guidance on terminology, application, and reporting of citation searching: the TARCiS statement","volume":"385","author":"J Hirt","year":"2024","journal-title":"BMJ"},{"key":"pone.0345868.ref032","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jclinepi.2016.01.021","article-title":"PRESS peer review of electronic search strategies: 2015 guideline statement","volume":"75","author":"J McGowan","year":"2016","journal-title":"Journal of clinical epidemiology"},{"issue":"3","key":"pone.0345868.ref033","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3163\/1536-5050.104.3.014","article-title":"De-duplication of database search results for systematic reviews in EndNote","volume":"104","author":"WM Bramer","year":"2016","journal-title":"J Med Libr Assoc"},{"issue":"4","key":"pone.0345868.ref034","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/01.XEB.0000511346.12446.f2","article-title":"Covidence vs Excel for the title and abstract review stage of a systematic review","volume":"14","author":"M Macdonald","year":"2016","journal-title":"International Journal of Evidence-Based Healthcare"},{"issue":"1","key":"pone.0345868.ref035","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"JR Landis","year":"1977","journal-title":"Biometrics"},{"key":"pone.0345868.ref036","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/978-3-030-71921-0_6","article-title":"Data extraction from included studies","volume-title":"Principles and practice of systematic reviews and meta-analysis","author":"K Moon","year":"2021"},{"key":"pone.0345868.ref037","unstructured":"Institute JB. Checklist for Prevalence Studies. Critical Appraisal tools for use in JBI Systematic Reviews. 2020."},{"key":"pone.0345868.ref038","unstructured":"Bias Ro. ROBINS-E tool. [Available from: https:\/\/www.riskofbias.info\/welcome\/robins-e-tool"},{"issue":"32","key":"pone.0345868.ref039","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.200077","article-title":"Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses","volume":"192","author":"S Schandelmaier","year":"2020","journal-title":"CMAJ"},{"issue":"1","key":"pone.0345868.ref040","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12961-018-0320-2","article-title":"The GRADE Evidence to Decision (EtD) framework for health system and public health decisions","volume":"16","author":"J Moberg","year":"2018","journal-title":"Health Res Policy Syst"},{"issue":"1","key":"pone.0345868.ref041","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/1536867X0900900103","article-title":"Multivariate Random-effects Meta-analysis","volume":"9","author":"IR White","year":"2009","journal-title":"The Stata Journal: Promoting communications on statistics and Stata"},{"issue":"3","key":"pone.0345868.ref042","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1136\/jnnp-2015-310361","article-title":"Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios","volume":"87","author":"A Manouchehrinia","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"25","key":"pone.0345868.ref043","doi-asserted-by":"crossref","first-page":"3923","DOI":"10.1002\/sim.7411","article-title":"The Hartung-Knapp modification for random-effects meta-analysis: A useful refinement but are there any residual concerns?","volume":"36","author":"D Jackson","year":"2017","journal-title":"Stat Med"},{"issue":"1","key":"pone.0345868.ref044","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/jrsm.1230","article-title":"Basics of meta-analysis: I2 is not an absolute measure of heterogeneity","volume":"8","author":"M Borenstein","year":"2017","journal-title":"Res Synth Methods"},{"issue":"10","key":"pone.0345868.ref045","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/jamainternmed.2022.3697","article-title":"Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study","volume":"182","author":"RT Brown","year":"2022","journal-title":"JAMA Intern Med"},{"key":"pone.0345868.ref046","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/978-3-031-13942-0_2","article-title":"Doing Reflexive Thematic Analysis","volume-title":"Supporting Research in Counselling and Psychotherapy","author":"V Braun","year":"2022"},{"key":"pone.0345868.ref047","doi-asserted-by":"crossref","DOI":"10.1177\/16094069241299660","article-title":"Community Consultations to Support Scoping Review Knowledge Dissemination","volume":"24","author":"SL Canham","year":"2025","journal-title":"International J Qualitative Methods"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345868","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:33:52Z","timestamp":1782322432000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345868"}},"subtitle":[],"editor":[{"given":"Bibha","family":"Simkhada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345868","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}