Language-Related Disparities in History Documentation in Patients Admitted for Heart Failure
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Introduction
Patients hospitalized with heart failure who do not speak English as their primary language face communication barriers, however the impact on documented History of Present Illness (HPI) and Review of Systems (ROS) has not been reported.
Methods
This retrospective cohort study was based on MIMIC-IV, an anonymized clinical database. Adult patients admitted to general medicine or cardiology services with heart failure (by DRG) were identified. Multivariable linear regression was used to assess for an association between language (English vs. non-English) and word counts for HPI+ROS and HPI word counts. Qualitative differences in texts were also analyzed using Claude Opus 4.6.
Results
In a cohort of 552 patients, non-English language (N = 81) was associated with a shorter HPI+ROS (coef. -33.387, 95% CI [-62.076, -4.697], p = 0.023) controlling for age (coef. -1.023, 95% CI [-1.817, -0.230], p = 0.012) and Elixhauser score (coef. 10.391, 95% CI [7.078, 13.705], p<0.001). Similar associations were found for HPI alone. Qualitative differences included less discussion of symptoms and timing of onset.
Discussion
HPI+ROS and HPI were more abbreviated when the primary documented language was not English. This has important implications for equitable care and the development of emerging translation and documentation technologies.
