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Today's VeTerinary PracTice | september/october 2015 | tvpjournal.com aHs HearTWorM HoTLine Peer reviewed 76 In the Literature a 2009 study by the american animal Hospital association (aaHa) of veterinarians from aaHa clinics found that 51% of their clinics' clients complied with veterinary recommendations for administration of preventives. 3 However, a 2015 study conducted by Merial painted a more negative picture, fnding that an average of 63.5% of dogs in the U.s. left veterinary clinics without a heartworm preventive. 4 While the data do not reveal actual rates of compliance, based on the lack of correlation between the purchase of preventives and actual veterinary recommendations, it is worth noting that the percentage of dogs leaving the veterinary offce without heartworm medication ranged from: • 56% of dogs in the heartworm-endemic south and southeast regions • 63% and 65% of dogs, respectively, in the northeast and upper Midwest • 81% and 83% of dogs, respectively, in the rocky Mountain and Pacific northwest regions. Meanwhile, a 2014 survey conducted by aaHa found that veterinary visits are declining in frequency, with owners extending the time between visits. in 2009, dog owners averaged 11.5 months between veterinary visits; that number grew to 16.9 months by 2014. 5 s uch declines do not bode well for annual heartworm testing or timely heartworm preventive prescription renewal. even more alarming, more than 1 /3 of cats do not routinely visit a veterinarian, 5 and only a small TAbLe. Compliance Challenges: pros & Cons of heartworm prevention FaCtor proS ConS Cost • Heartworm preventives are affordable (approximately $10–$15/month) • This cost is a fraction of the cost of heartworm treatment • Most preventives provide the added value of protection from other internal and external parasites • Cost of annual heartworm testing may be hard to justify to pet owners who administer preventives regularly • Owners living in climates with cold winters may object to costs of year-round prevention • Owners with multiple pets may have diffculty affording preventives for all of them Safety & Side Effects • Heartworm preventives are safe for the vast majority of patients • Most patients experience no side effects from the medication Clients who prefer natural or holistic therapies may resist the concept of year-round chemoprophylaxis Complexity of Dosing easy to administer: • Flavor-enhanced chewable tablet • easy-to-apply topical • Simple subcutaneous injection Owner must ensure preventive is: • Swallowed • Not vomited • Not rubbed or washed off Convenience of Dosing Regimen Preventive dosing: • Once a month for oral and topical • every 6 months for injectable • Dosing may be considered too infrequent to be habitual • Administration reminders are needed Disease Awareness Owner awareness of canine disease tends to be high in areas where HWD is known to be common • Many cat and ferret owners are unaware of the need to prevent HWD • Owners in regions not traditionally recognized as heartworm-endemic may be unaware of risks Disease Education AHS (heartwormsociety.org): • Pet-owner education on website • Free client education materials Owners may be unaware of need for year- round prevention, especially: • In areas with cold seasons • With indoor pets Disease Complexity Think 12 • Heartworm testing every 12 months • Preventives administered 12 months a year Infection and prevention are complex processes that require time to explain Prevention Benefts Infection is almost 100% preventable No visible benefts to the owner as heartworms are internal parasites