Heart Care Info - Heart Disease Prevention & Treatment

Acculturation and Outcomes among Patients with Heart Failure

PN Peterson, EJ Campagna, M Maravi... - ... : Heart Failure, 2012 - Am Heart Assoc BackgroundAcculturation to US society among minority patients may influence health outcomes beyond race and ethnicity alone. In particular, those who are foreign-born and who do not speak English as their primary language may have greater challenges ...

Background—Acculturation to U.S. society among minority patients may influence health outcomes beyond race and ethnicity alone. In particular, those who are foreign-born and who do not speak English as their primary language may have greater challenges interacting with the health care system and thus be at greater risk for adverse outcomes.

Methods and Results—We studied patients hospitalized with a principal discharge diagnosis of HF between January 2000 and December 2007 in an integrated delivery system that cares for minority patients. Individuals were defined as having low acculturation if their as country of birth was outside of the U.S and their primary language was not English. Multivariable logistic regression and Cox proportional hazards regression were used to determine the independent risk of 30-day rehospitalization and 1-year mortality, respectively. Candidate adjustment variables included demographics (age, gender, race/ethnicity), coexisting illnesses, laboratory values, left ventricular systolic function, and characteristics of the index admission. Of 1,250 patients, 30% (n=375) were Black, 39% (n=489) Hispanic, and 28% (n= 344) White. Twenty-five percent (n=306) had low acculturation. After adjustment, low acculturation was associated with a higher risk of readmission at 30 days (OR 1.55; 95% CI 1.09-2.20) but not 1-year all-cause mortality (HR 1.35; 95% CI 0.92-1.97).

Conclusions—Patients with HF who are foreign-born and do not speak English as their primary language have a greater risk of rehospitalization, independent of clinical factors and race/ethnicity. Future studies should evaluate whether culturally concordant interventions focusing on such patients may improve outcomes for this patient population.