Abstract P80: Lack of English Comprehension is Associated with Delays in Hospital Presentation in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background: Prior studies have demonstrated an association between ethnicity and symptom onset to presentation time (S2PT) among patients presenting with ST elevation MI (STEMI) in the USA, with a shorter S2PT among Caucasians when compared with other ethnicities. However, little is known regarding whether or not a patient's ability to comprehend English impacts the S2PT. Methods: Consecutive patients presenting to 4 hospitals in NYC with STEMI referred for primary angioplasty were included in the analysis. S2PT was recorded on the day of the infarct based on the patient's account of the onset of symptoms. We assessed a patient's ability to comprehend English through telephone interviews conducted during routine follow-up. Results: Among 210 patients, 83.8% (176 of 210) had either some English comprehension or were fluent in English (E) and 16.2% (34 of 210) reported no English comprehension (non-E). Of the non-E patients, 65% (22 of 34) spoke Spanish, 6% (2 of 34) spoke Russian, 6% (2 of 34) spoke Chinese and 23% (8 of 34) spoke another language. The baseline variables and mean S2PT are depicted in the table. Non-E patients had a significantly higher S2PT compared to E patients even after adjusting for differences in baseline variables. Increased odds were also observed among non-E patients with a longer S2PT (adjusted odds ratio for S2PT > 120 minutes 2.17; 95% CI 01.03-4.54; p=0.04). This association remained constant even after adjusting for confounders like age, sex, ethnicity, level of education and comorbidities (diabetes, previous history of MI and PCI). Conclusions: S2PT is strongly influenced by a patient's ability to comprehend English. This information emphasizes the need for more aggressive “multi-lingual” educational outreach and the use of multi-lingual emergency lines in an effort to decrease total ischemic time during STEMI. English Comprehension Fair or Good (N=176) No English Comprehension (N=34) P Age Mean (SD) 62 (14.2) 65 (11) 0.22 Male sex n (%) 129 (73) 26 (76) 0.70 Diabetes n (%) 25 (14) 9 (27) 0.09 Hypertension n (%) 107 (66) 20 (62.5) 0.70 Prior MI n (%) 21 (12) 2 (6) 0.284 Prior PCI or CABG n (%) 12 (6.8) 2 (6) 0.960 Education: n (%) 40 (23) 12 (35) 0.09 Less than HS 62 (35) 8 (23) HS Diploma 8 (4) 0 (0) College Diploma Unknown 66 (38) 14 (42) Mean S2P time (SD) 225 (315) 387 (820.6) 0.05 S2P time > 120 minutes n (%) 70 (40) 20 (62.5) 0.04