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English as a second language and outcomes of patients presenting with acute coronary syndromes: results from the CONCORDANCE registry

Craig P Juergens, Bilyana Dabin, John K French, Leonard Kritharides, Karice Hyun, Jens Kilian, Derek PB Chew and David Brieger
Med J Aust 2016; 204 (6): 239. || doi: 10.5694/mja15.00812

Summary

Objectives: To investigate whether patients with English as their second language have similar acute coronary syndrome (ACS) outcomes to people whose first language is English.

Design: Retrospective, observational study, using admissions, treatment and follow-up data.

Participants and setting: : A total of 6304 subjects from 41 sites enrolled in the investigator-initiated CONCORDANCE ACS registry.

Main outcome measures: Baseline characteristics, treatments, and in-hospital and 6-month mortality.

Results: English as a second language (ESL) was reported by 1005 subjects (15.9%). Patients with English as their first language (EFL) were older, and were less likely to have diabetes mellitus or to smoke than the ESL patients. Prior myocardial infarction, heart failure and chronic renal failure were more common in the ESL group. In-hospital mortality was also higher in these patients (7.1% v 3.8% for EFL patients; P < 0.001). Predictors of in-hospital mortality included presentation in cardiogenic shock, cardiac arrest in hospital, a history of renal failure, prior cardiac failure, and ESL. Rates of cardiac catheterisation, percutaneous coronary intervention rates, and referral to cardiac rehabilitation were lower in the ESL group; at 6 months, all-cause mortality was also higher (13.8% v 8.3% for EFL group; P < 0.001). Logistic regression identified language, age, in-hospital renal failure, and recurrent ischaemia as predictors of 6-month mortality.

Conclusion: Patients presenting with an ACS who report English as their second language have poorer outcomes than patients who use English as their first language. This difference may not be entirely explained by baseline demographic disparities or management differences.

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  • Craig P Juergens1,6
  • Bilyana Dabin2
  • John K French1,6
  • Leonard Kritharides2
  • Karice Hyun3
  • Jens Kilian4
  • Derek PB Chew5
  • David Brieger2

  • 1 Liverpool Hospital, Sydney, NSW
  • 2 Concord Repatriation Hospital, Sydney, NSW
  • 3 The George Institute for Global Health, Sydney, NSW
  • 4 Bankstown Hospital, Sydney, NSW
  • 5 Flinders Medical Centre, Adelaide, SA
  • 6 South Western Sydney Clinical School, University of NSW, Sydney, NSW

Correspondence: C.Juergens@unsw.edu.au

Acknowledgements: 

We thank all the investigators and study coordinators who contributed to the CONCORDANCE Registry.

Competing interests:

The CONCORDANCE registry has been funded by grants to the Sydney Local Health District from Sanofi Aventis, Astra Zeneca, Eli Lilly, Boehringer Ingelheim, the Merck Sharp and Dohme/Schering Plough joint venture, and the National Heart Foundation of Australia. The sponsors played no role in the design, analysis, or preparation of this article.

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access_time 09:16, 29 April 2016
dani fried

Thanks for this article. I wonder whether you have considered the fact that not all ESL individuals are from overseas. As well as ATSI people, who you have mentioned, Deaf individuals are frequently monolingual in Auslan, or have limited bilingualism in Auslan and English. They frequently do not have access to any (or high quality) interpreting services in medical settings. They are further disadvantaged by the fact that health information is rarely made available in Auslan, and because, unlike many other NESB groups, there are no clinicians available who speak their language. I'd encourage researchers to always make sure that this small but significant group of NESB people are included in future research on the impact of language and culture on health outcomes.

Competing Interests: No relevant disclosures

Ms dani fried
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access_time 10:18, 3 May 2016
Craig Juergens

Thanks for your comments. ESL was by self report so they were not necessarily from overseas. 418 patients identified themselves as Aboriginal or Torres Strait Islander and we have not analysied what proportion of these patients, if any, identified as ESL which would be interesting. We did not collect data on deaf patients or the use of Auslan interpreters and agree this is an even more poorly studied population in this context.

Competing Interests: No relevant disclosures

Assoc Prof Craig Juergens
Liverpool Hospital

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