Impact of limited English proficiency on presentation and outcomes of patients undergoing primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Abstract

Doctor-patient language discordance has been shown to lead to worse clinical outcomes. In this study of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction at an Australian health service, we demonstrated that limited English proficiency (LEP) is an independent predictor of prolonged symptom-to-door time, but does not lead to worse 30-day mortality compared with English-proficient patients. More effort needs to be placed in providing public health education in varied languages to encourage early presentation to hospital for patients with LEP.

Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review

“…Most (15/26 [57.7%]) studies were conducted in the USA, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] with the remainder conducted in Australia and/or New Zealand, [27][28][29][30][31][32] or Canada [33][34][35][36][37] (Appendix 2). All USA-based studies were conducted in one of 5 states (California, 15,19,21,24,26 Massachusetts, 16,17,23,25 New Jersey, [12][13][14] New York, 20,22 or Minnesota 18 ).…”

“…31 Most studies included patients admitted with exclusively medical conditions or general hospital populations, though 4 focused on surgical conditions 13,14,17,36 and 1 focused on a procedural intervention. 28 Three studies examined the ICU setting 16,18,29 and 3 the ED setting. 22,23,26 All studies reported patient age and sex or gender, 12 included race and/or ethnicity, 9 included insurance type, and 9 included income status or a similar measure.…”

“…There was substantial variation in the definition of the LEP or analogous group. A majority (16/26) of studies assessed patient language by a version of self-report [12][13][14]16,17,19,[21][22][23][24]28,29,32,34,35,37 -most commonly employing the language listed in the electronic health record as originally reported by the patient-while 1 used translator requirement. 26 Few studies (6/26) confirmed patient language using multiple methods, such as self-report and interpreter services records, 15,25 research assistant interview, 33 partial or full manual validation of medical records, 18,36 or discussion with the care team combined with chart review.…”

“…[12][13][14][16][17][18][19]21,25,[28][29][30][31][32][33]36,37 Of these, 13 adjusted for at least 1 patient-level baseline characteristic. Findings were variable, with 9 studies reporting no association between LEP and LOS, 12,14,17,19,21,28,30,32,36 4 studies reporting longer LOS in LEP patients, 18,29,31,33 and 3 reporting shorter LOS in LEP patients; 16,25,37 1 study reported mixed results across different surgery types. 13 In some cases, differences in LOS appeared to be conditiondependent.…”

Physician–Patient Language Discordance and Poor Health Outcomes: A Systematic Scoping Review

“…Other studies, however, had wholly inaccurate definitions of language concordance, such as Mehler et al (31), who used patients' ethnicity and immigrant status as a proxy for limited English proficiency (LEP). Similarly, Biswas et al (21) defined LEP patients as any participant who did not self-report English as their primary language, negating the existence of multilingual participants. The majority of studies used self-reported surveys and questionnaires to collect data on preferred language and language fluency among patients and physicians, while other studies used electronic medical databases to access patients' primary language(s).…”