Except the clinic I work for alone in a town of under 2500 people had over 40 heartworm positive tests just last year. When I lived in a Wyoming the clinic I work for only pushed heartworm prevention in the warmer summer months down here in Texas it is a concern year round.
When we got Luca he was 7 months old and already had HW. We did the "alternate treatment" as I call it----the antibiotics and monthly prevention. He tested clean after the first round, thank goodness. My daddy also had to do it with one of his older dogs. Took several rounds with Rastus, but he finally tested clean also. Down here in the dirty (!!) South we have to watch out for this year round.