Outcomes after Heart Transplantation among Non-Native English-Speaking Recipients.

Abstract

Introduction: Effective communication and understanding are imperative for heart transplant (HT) recipients who require lifelong adherence to treatment plans and medications. Whether non-native English speaking (NNES) recipients have inferior outcomes compared to native English-speaking recipients (NES) has not been studied post-HT.

Methods: We reviewed adult HT recipients at Columbia University Irving Medical Center from January 2005 through December 2022 with primary language determined by chart review. Baseline characteristics and patient level zip codes which were used to derive socioeconomic status (SES) index using data from the Agency for Healthcare Research and Quality (AHRQ) were included. Mortality at 1-year and 5-year was compared between NNES and NES. Survival curves were estimated by the Kaplan-Meir method and log-rank testing was used to compare survival between groups. Secondary outcomes including hospitalization, hospitalization for infection, and rejection at 1-year, as well as rejection and CAV at 5-years were analyzed using cumulative incidence functions with Gray's testing to detect outcome differences between groups. Multivariable Cox proportional hazard models were constructed to determine if there was an association between NNES and primary and secondary outcomes.

Results: Of 1,066 HT recipients, 103 (10%) were NNES. NNES recipients were more likely to identify as non-White, have Medicaid as the primary payer, and have lower educational attainment. On average, NNES recipients resided in zip codes with higher levels of unemployment, lower educational attainment, and lower household incomes. Overall, NNES had lower median AHRQ SES indices (51 vs 55, p<0.001). After adjustment for clinical factors including socioeconomic status, race/ethnicity, and education level, mortality at 1- and 5-years for NNES and NES recipients were not significantly different although there was a trend towards improved survival in the NNES group (1-year adjusted hazard ratio (HR) 0.24, 95% CI 0.06-1.01, p=0.05; 5-year adjusted HR 0.48, 95% CI 0.22-1.03, p=0.06). Similarly, there were no differences in need for re-hospitalization, infection requiring hospitalization, and rejection at 1 year.

Conclusions: There were no significant differences in outcomes at 1 year and 5 years post-HT among NNES and NES. Availability of interpreter services and educational resources in multiple languages are paramount to maintaining effective communication and equitable outcomes.

Lay summary: Although the population of individuals living with heart failure in the United States is incredibly diverse, little is known about whether non-Native English speakers (NNES) fare differently after heart transplantation. In this study of over 1000 heart transplant recipients, we found that although NNES patients were more likely to be non-White, had lower education status and had public insurance, outcomes were similar at 1- and 5-years after transplant.