Breaking barriers in heartworm care: Practical strategies for preventing, diagnosing, and treating canine heartworm disease 

According to the American Heartworm Society (AHS), over one million dogs in the United States have heartworms despite it being a preventable disease. That number reflects not just medical gaps, but missed opportunities. 

The good news? There’s a growing body of evidence-based protocols that can help more pets get the care they need, while also supporting practice efficiency and revenue. The key lies in understanding – and removing – barriers at every step of care: prevention, diagnosis, and treatment. 

Know the Barriers 

Barriers to heartworm care don’t only come from clients. Patients and providers face challenges too. Identifying these early can help your practice respond proactively. 

• Client barriers include financial constraints, lack of awareness, confusion about options, or discomfort during visits.
• Patient barriers can include difficulty tolerating medications, anxiety with clinic visits, or challenges following treatment protocols (e.g., exercise restriction).
• Provider barriers may be less obvious but are just as critical: limited availability of melarsomine, lack of familiarity with alternative treatment protocols, or restricted payment options for clients. 

Prevention: We Can Do Better 

In 2024, Boehringer Ingelheim reported that 68% of dogs who visited a veterinarian left without purchasing heartworm prevention, either in-clinic or online. When factoring in pets who never see a vet annually, the problem becomes even more urgent. 

Here’s how to address the most common client-side barriers with clear, actionable solutions: 

Safety Concerns 

Macrocyclic lactones, the drug class used in all FDA-approved heartworm preventives, have been on the market for nearly 40 years and carry one of the lowest adverse event profiles in veterinary medicine. Did you know ivermectin, the original heartworm preventive, was derived from soil samples? That’s about as natural as it gets! 

Lack of Perceived Risk 

Clients often say things like, “My dog is indoors,” or “We live in a gated community.” Respond with compassion and evidence. Share regional prevalence maps and discuss the life cycle or finer points of heartworm disease to drive home the importance of prevention and shift perspectives. 

Financial Constraints  

Nearly 80% of Americans are living paycheck to paycheck. Help clients access a range of options, such as generic monthly prevention for as little as $6–$7, or combination flea/tick/heartworm products around $16/month. Auto-shipping and monthly billing help clients budget more easily. Use comparisons clients can easily relate to: “One fewer coffee stop a month could cover prevention.” 

Difficulty With Administration 

With oral, topical, and injectable options available, most administration issues can be solved with a quick conversation about preferences and lifestyle. 

Confusion and Conflict 

Mixed messages from team members or a lack of clear cost estimates can erode trust. Make visit expectations transparent. Train the whole team to deliver consistent messaging, and ensure pricing is clear up front – even before a patient arrives to the practice, whenever possible. 

Decision Fatigue 

Clients can be overwhelmed by too many choices in a short visit. Stick to three decisions or fewer per appointment. Bundled wellness packages (e.g., Plan A, B, or C) reduce mental load and improve compliance. 

Bonus Tip: Third-party payment platforms like Scratchpay, Care Credit, Vetbilling or Varidi and wellness plan providers like Petly can also ease both cost and decision fatigue by spreading payments over time. 

Diagnosis: Small Changes, Big Impact 

Sometimes the biggest obstacle to prevention is simply getting the test done. 

Consider bundling heartworm testing into your annual wellness plans or preventive care packages. Point-of-care antigen tests cost as little as $3 wholesale, and even a quick microfilaria check is budget-friendly. Removing testing as a separate “ask” increases client compliance. 

Have clients who struggle to get to the clinic? Consider collaborating with a local mobile vet service or offering limited house calls. 

Treatment: A Spectrum of Options 

Heartworm treatment used to feel like an all-or-nothing scenario: either clients opted into the full three-dose melarsomine protocol, or the pet went untreated. That’s no longer the case. 

Here’s how to expand options and support better outcomes: 

1. Identify client, patient, and provider barriers.
2. Offer a range of evidence-based protocols to fit different needs if the full protocol is inaccessible 
3. Review options using the “3 Cs”: cost, convenience, and choice.
4. Document client decisions clearly and move forward.
    

Protocols like “Moxi-Doxy” (monthly moxidectin, either injectable or topical, combined with doxycycline) offer a cost-effective, low-complication alternative for clients unable to pursue melarsomine treatment. Multiple studies have demonstrated strong efficacy and safety. 

For others, a two-injection melarsomine protocol may serve as a middle-ground approach. 

And for clients who want the standard three-injection protocol but face financial hurdles, streamlined workflows and payment plans can close the gap. 

Key Reminders: 

• Doxycycline and macrocyclic lactones are always part of the treatment plan.
• Activity restriction is critical during treatment to reduce cardiopulmonary complications.
• Monitor each step and share decision making with your clients as you go. 

Practical Tools and Next Steps 

Want to dig deeper or streamline protocols in your own practice? Check out these resources: 

• 2024 AHS Guidelines – The latest science on prevention and treatment.
• AHS Triennial Symposium – Stay up to date with new findings and connect with peers.
• CE Course – Developed by AHS and Open Door Veterinary Collective, this RACE-approved, interactive one-hour course offers practical downloads and side-by-side treatment protocol comparisons.
• Toronto Humane Society Data – Keep an eye out for emerging evidence on additional life-saving HWD protocols.

The Bottom Line 

Heartworm disease remains a serious, yet preventable and treatable, threat to canine health. By identifying barriers at every level, including the client, patient, and provider, we can help clients accept and follow through with care plans, improve outcomes for pets, and support our veterinary teams at the same time. 

 

Photo Credit: Olena Miroshnichenko via iStock/Getty Images+ 

Disclaimer: Trends content is meant to inform, educate, and inspire by providing an array of diverse viewpoints. Any content published should not be viewed as an official stance, position, or endorsement by the American Animal Hospital Association (AAHA) or its Board of Directors.