Is there inequity amongst patients with acute coronary syndrome who are proficient and not proficient in English language in terms of their in-hospital care: Analysis of the SNAPSHOT ACS Study

Background: The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand (NZ) requires an understanding of the sources of variation in the provision of this care. Objective: To compare the variation in care and outcomes between acute coronary syndrome (ACS) patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and New Zealand (NZ) hospitals. Methods: Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between 14-27 May 2012 who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions. Results: The 294 LEP patients were older (70.9 years vs. 66.3, p<0.001), had higher prevalence of hypertension (71.1% vs. 62.8%, p=0.004), diabetes (40.5% vs. 24.3%, p<0.001) and renal impairment (16.3% vs. 11.1%, p=0.007) compared to the 4093 EP patients. Once in hospital, there was no difference in receipt of percutaneous coronary intervention (57.0% vs. 55.4%, p=0.78) or coronary artery bypass graft surgery (10.5% vs. 11.5%, p=0.98). Following adjustment for the past medical history, there were no significant differences (p>0.05) between the two groups in the risk of major adverse cardiovascular events and/or all-cause death, during the index admission and from index admission to 18 months. Conclusions: These results suggest that LEP patients admitted to Australian or NZ hospitals with suspected ACS may not suffer inequity in in-hospital care and outcomes.