Is early treatment of acute chest pain provided sooner to patients who speak the national language?

Objective: Identify differences in the early treatment of acute chest pain patients with regard to the language proficiency of patients and thus identify opportunities for improving equity in cardiac care.

Design: Retrospective cross-sectional study comparing care delivered to Swedish-speaking (SS) and non-Swedish-speaking (NSS) patients.

Setting: A Swedish university hospital that provides highly specialized care to 1.6 million inhabitants.

Participants: All patients with acute chest pain or symptoms suggestive of acute coronary syndrome who sought care between mid-September and mid-December 2008 (2588 visits). Missing data on the patient group to which study subjects belonged were 2% (45 visits). NSS represented 8% of the 2543 visits (NSS = 2334; NNSS = 209).

Main outcome measure(s): Delay times from arrival in hospital to admission to catheterization laboratory or ward (ΔTHOSP-PCI), first physical contact to first electrocardiogram (ΔTCONTACT-ECG), first physical contact to first aspirin (ΔTCONTACT-ASA) and arrival in hospital to coronary angiography (ΔTHOSP-ANGIO). Also included baseline characteristics of patients, diagnosis and findings in hospital and secondary preventive activities.

Results: The median ΔTHOSP-PCI was longer for NSS by 43 min [254 versus 211, 95% confidence interval (CI), odds ratio (OR) = (1.3; 2.8)]. The median ΔTCONTACT-ECG and ΔTHOSP-ANGIO were longer for NSS by 4 min [17 versus 13, 95% CI, OR = (0.8; 1.8)] and 14 h [44 versus 30, 95% CI, OR = (0.6; 3.6)], respectively. Conversely, the median ΔTCONTACT-ASA was longer for SS by 20 min [81 versus 61, 95% CI, OR = (0.3; 1.6)].

Conclusions: Poorer language proficiency was associated with longer delay time from arrival in hospital to admission to catheterization laboratory or ward. No other delay times were found to be statistically significantly different with respect to the language proficiency of patients.