title: English as a second language and outcomes of patients presenting with acute coronary syndromes: results from the CONCORDANCE registry.
abstract: OBJECTIVE
  To investigate whether patients with English as their second language have similar acute coronary syndrome (ACS) outcomes to people whose first language is English.
  
  
  METHODS
  Retrospective, observational study, using admissions, treatment and follow-up data.
  
  
  METHODS
  A total of 6304 subjects from 41 sites enrolled in the investigator-initiated CONCORDANCE ACS registry.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liverpool Hospital, Sydney, NSW C.Juergens@unsw.edu.au.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
authors.affiliation: Concord Repatriation Hospital, Sydney, NSW.
authors.forename: Bilyana
authors.initials: B
authors.lastname: Dabin
authors.affiliation: Liverpool Hospital, Sydney, NSW.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Concord Repatriation Hospital, Sydney, NSW.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
authors.affiliation: The George Institute for Global Health, Sydney, NSW.
authors.forename: Karice
authors.initials: K
authors.lastname: Hyun
authors.affiliation: Bankstown Hospital, Sydney, NSW.
authors.forename: Jens
authors.initials: J
authors.lastname: Kilian
authors.affiliation: Flinders Medical Centre, Adelaide, SA.
authors.forename: Derek Pb
authors.initials: DP
authors.lastname: Chew
authors.affiliation: Concord Repatriation Hospital, Sydney, NSW.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy; D000368:Aged; D001315:Australia; D003144:Communication Barriers; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome