Outcomes After Heart Transplantation Among Non-Native English-Speaking Recipients

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.

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

Of 1066 HT recipients, 103 (10%) were NNES. NNES recipients were more likely to identify as non-White, to have Medicaid as the primary payer and to have lower educational attainment. On average, NNES recipients resided in zip codes with higher levels of unemployment 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 toward improved survival rates 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 rehospitalization, infection requiring hospitalization or rejection at 1 year.

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