Prevalence and Risk of Heart Failure Among Older Adults Experiencing Homelessness: A Systematic Review and Meta-Analysis

Abstract

Background
Understanding the prevalence and risk of heart failure (HF) among older adults is crucial for informing the design and implementation of interventions and guiding equitable healthcare delivery.

Methods

A systematic search was conducted in MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, and Web of Science from inception to April 2025. We included studies of adults aged 50 years or older experiencing homelessness. Outcomes included HF prevalence, risk of HF, and HF mortality. Screening, extraction, and risk-of-bias assessments were completed in duplicate. Random effects meta-analysis using generalized linear mixed models was used to estimate the prevalence of HF. The risk and mortality of HF were analyzed using random effects models, with housed older adults serving as the comparator.

Results

Thirty-four studies with 573,697 individuals experiencing homelessness were included in this study (weighted mean age: 59.0 years, weighted female percentage: 19.9%). The prevalence of HF was 12.0% (95% confidence interval (CI) 7.3–19.0; I² = 99.9%). The odds of HF compared to housed adults (weighted mean age: 70.8 years) was 0.93 (95% CI 0.71–1.23; I² = 99.7%). The unadjusted odds of mortality from HF was 0.40 (95% CI 0.22–0.74; I² = 100%).

Conclusions
This meta-analysis suggests that older adults experiencing homelessness have a prevalence of HF similar to or higher than population-based studies of housed adults of a similar age. Housing status was not associated with the odds of HF and was associated with a decreased odds of mortality, although substantial heterogeneity across studies limits evidence certainty.