Cardiovascular Risk Factors Identified Among Homeless Adults in San Francisco: Recommendations for Evidence-Based Outreach Services From a Quality Improvement Initiative

Abstract Objective This preliminary public health report assessed acute and chronic health burdens, focusing on cardiovascular health, among unsheltered individuals experiencing homelessness. It aims to guide medical referrals, deliver targeted health education, and prioritize services within a community-based nonprofit. Methods A field-based needs assessment used a structured questionnaire to evaluate acute and chronic health burdens. Clinical measures included blood pressure (BP), heart rate (HR), pain scores (normalized to 0–10), nicotine use, and diabetes prevalence. Of 72 initial responses, 59 BP, 65 HR, and 66 pain scores were usable. BP was classified per ACC/AHA (2017) guidelines [1], including Hypertensive Crisis. Nicotine and diabetes data from a secondary survey yielded 39 and 38 usable responses of 116. Ethical oversight ensured informed consent, participant capacity assessment, and emergency protocols. Data were analyzed descriptively. Results Participants were predominantly male (N = 53 of 72) with ages ranging from 24 to 70 years (Mean = 42.96; Median = 41; N = 70). The cohort was primarily White/Caucasian (N = 30) and Black/African American (N = 27). Cardiovascular assessments revealed substantial acute risk: 72.88% (N = 43 of 59) of BP readings were classified as Total High Blood Pressure, and 10.17% (N = 6 of 59) met criteria for Hypertensive Crisis or higher, including readings of 210/137 mmHg and 286/127 mmHg. Mean and median HR were both 96 bpm (N = 65). Chronic symptom burden was notable, with a mean pain score of 3.74 and 19.70% (N = 13) reported severe pain (7–10). Self-reported comorbidities included current smoking in 15.38% (N = 6 of 39) and a history of diabetes in 13.16% (N = 5 of 38). Conclusion Findings show a high prevalence of acute cardiovascular risk, particularly severe hypertension, among the unsheltered population. These results highlight the urgent need for improved outreach, targeted cardiovascular and primary care referrals, and follow-up screenings. Expanding health education on the effects of uncontrolled diabetes and smoking is recommended to reduce future cardiovascular events. Highlights Hypertensive Crisis prevalence: 10.17% (N = 6) of usable BP ratios (N = 59) met the criteria for Hypertensive Crisis or Higher (SYS ≥ 180 OR DIA ≥ 120). Overall prevalence of High Blood Pressure (Stage 1 or higher): 72.88% (N = 43) of usable BP ratios (N = 59), representing a pervasive, unmanaged health condition. Elevated Mean Cardiac Activity: The calculated Mean Heart Rate was 96 (N = 65 usable entries), with a Median Heart Rate of 96, suggesting chronic stress or underlying conditions. High Chronic Pain Burden: 19.70% (N = 13) of participants reported severe pain scores of 7-10 (N = 64 usable scores after transformation). Demographic Context: The cohort included 72 usable responses with a mean age of 42.96 years. Sex distribution records 55 males, 13 females, and 4 unknown/missing entries. Race distribution records 30 White/Caucasian, 27 Black/African American, 3 Hispanic/Latinx, 2 Native American/Indigenous American, six other/unspecified, and four unknown/missing entries. Nicotine Use Prevalence: 15.38% (N = 6) of participants reported nicotine use. All forms of nicotine products, including cigarettes and smokeless tobacco, were combined for analysis, while non-nicotine product substances were excluded. Diabetes Prevalence: 13.16% (N = 5) of participants self-reported a diagnosis of diabetes. All forms of diabetes were combined into a single variable for analysis.