Relationship Between Language Preference and Intravenous Thrombolysis Among Acute Ischemic Stroke Patients

Abstract

BackgroundApproximately 20% of the US population primarily speaks a language other than English at home. Yet the effect of language preference on treatment of acute ischemic stroke (AIS) patients remains unknown. We aimed to evaluate the influence of language preference on AIS patients’ receipt of intravenous (IV) thrombolysis.Methods and ResultsWe analyzed data from 3894 AIS patients who participated in the American Heart Association “Get With The Guidelines®—Stroke” program at our hospital from January 1, 2003 to April 30, 2014. Information included patients’ language in which they preferred to receive medical care. We used descriptive statistics and stepwise logistic regression models to examine associations between patients’ language preference and receipt of IV thrombolysis, adjusting for relevant covariates. A total of 306/3295 (9.3%) AIS patients preferred to speak a non‐English language and represented 25 different languages. Multivariable analyses adjusting for other socioeconomic factors showed that non‐English‐preferring patients were more likely than English‐preferring patients to receive IV thrombolysis (OR=1.64; CI=1.09‐2.48; P=0.02). However, in models that also included age, sex, and initial NIH Stroke Scale, patients’ language preference was no longer significant (OR 1.38; CI=0.88‐2.15; P=0.16), but NIH Stroke Scale was strongly associated with receiving IV thrombolysis (OR=1.15 per point; CI=1.13‐1.16; P<0.0001).ConclusionsContrary to our hypothesis, non‐English‐preferring was not associated with lower rates of IV thrombolysis among AIS patients once initial stroke severity was accounted for.

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

“…We previously reported that 9.3% of AIS patients cared for at our institution were NEP and that they were more likely than English-speaking patients to self-identify as racial/ethnic minorities, to be uninsured or have Medicaid, and to live in neighborhoods with higher poverty levels. 8 Several potential barriers may have affected NEP AIS patients who did not receive PMI services despite our institutional policies and systems to facilitate PMI use. Treating clinicians may have perceived a lack of available PMIs, experienced time constraints, or preferred to communicate through other means including ad hoc interpretation by patients' family members or other hospital staff.…”

“…As we described previously, GWTG‐Stroke is a national data collection system and performance measurement tool developed by the American Heart Association to improve the quality of care and outcomes for patients with stroke and transient ischemic attack 8. Our institution is a 999‐bed hospital in Boston, MA, with longstanding efforts to provide quality stroke care per nationally accepted standards and recommendations.…”

“…As we described previously, GWTG-Stroke is a national data collection system and performance measurement tool developed by the American Heart Association to improve the quality of care and outcomes for patients with stroke and transient ischemic attack. 8 Our institution is a 999-bed hospital in Boston, MA, with longstanding efforts to provide quality stroke care per nationally accepted standards and recommendations. Hospital personnel are trained to use GWTG-Stroke to collect data on AIS patients by prospective clinical identification or retrospective use of International Classification of Diseases, Ninth Revision and Tenth Revision discharge codes.…”

“…The role of PMIs in the care of stroke patients is largely unknown; we are aware of only 1 Australian study that showed patients undergoing inpatient stroke rehabilitation who needed and received PMI services had a greater change in their functional independence rate compared with patients who needed but did not receive PMI services 7. Our group previously described the influence of acute ischemic stroke (AIS) patients’ language preference on their receipt of intravenous thrombolysis 8. In this follow‐up study, we analyzed the effect of involving PMI in the care of non–English‐preferring (NEP) patients who participated in our institutional stroke registry.…”

“…7 Our group previously described the influence of acute ischemic stroke (AIS) patients' language preference on their receipt of intravenous thrombolysis. 8 In this follow-up study, we analyzed the effect of involving PMI in the care of non-English-preferring (NEP) patients who participated in our institutional stroke registry. We hypothesized that NEP patients who did not receive PMI services would be less likely to achieve defect-free AIS care.…”