English as a second language and outcomes of patients presenting with acute coronary syndromes: results from the CONCORDANCE registry

We thank Gray for his interest in our article.1 We chose the dichotomy of English as a first or second language based on patient self-report; we did not obtain specific data on spoken or written English proficiency, nor did we collect data on the use of professional interpreters throughout the course of our study. We agree that this would help to further inform our conclusions. As clinicians, we endeavour to use the services of professional interpreters to obtain the clinical history, ensure informed consent for procedures, communicate discharge instructions, and to answer any concerns that the patient may have. This often requires engaging a phone interpreter due to limited availability of interpreters for face-to-face interaction in a timely fashion.