babies worldwide Heart attack diagnosis missed in women more often than in men

Women’s Health

response to this pandemic and in future health crises.

Dr Erkan Kalafat, a co-author of the study from Koc University, Turkey, said: “We have an unprecedented opportunity to learn from the experiences of the COVID-19 pandemic to plan for a future of inclusive and equitable maternity care worldwide. One such learning opportunity will be to investigate the mechanisms underlying the apparent reduction in preterm births observed in high-income settings during the pandemic, with a view to identifying new preventative interventions that could potentially benefit all women worldwide.”

Study limitations

The authors note several limitations to their findings. Notably, the studies included in their analysis varied in the way pregnancy outcomes were defined and measured, which makes it difficult to compare results between studies. There were fewer studies from low- and middleincome settings, and this is concerning as the analysis shows substantial variation in outcomes between high- and low-income settings. The authors also note that they cannot exclude the risk of publication bias against studies reporting negative findings, although they did not find any evidence of bias when they tested for this.

Writing in a linked Comment article, Dr Jogender Kumar, of the Postgraduate Institute of Medical Education and Research, India, who was not involved in the study, said: “There was significant heterogeneity in outcomes between HICs and LMICs, and the rates of the adverse outcomes were much higher in LMICs. These findings highlight disparities in health care within and across countries.”

He added: “In resource-poor countries, even under normal circumstances, it is a challenge to provide adequate coverage for antenatal check-ups, obstetric emergencies, universal institutional deliveries, and respectful maternity care. The COVID-19 pandemic has widened this gap and exposed several lacunae of healthcare systems worldwide, but more so in LMICs.”

The study was carried out by researchers from St George’s University of London (UK), Middle East Technical University (Turkey), Koc University (Turkey), London School of Hygiene and Tropical Medicine (UK), The Royal College of Obstetricians and Gynaecologists (UK), University College London Hospitals NHS Foundation Trust (UK), Norfolk and Norwich University Hospitals NHS Foundation Trust (UK), North Bristol NHS Trust (UK), University of Birmingham (UK), Public Health England (UK), Royal College of Paediatrics and Child Health (UK) and Kings College London (UK).

Reference:

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. The Lancet Global Health. doi: https://doi. org/10.1016/S2214-109X(21)00079-6

Heart attack diagnosis missed in women more often than in men

Chest pain is misdiagnosed in women more frequently than in men, according to research presented March 10 at ESC Acute CardioVascular Care 2021, an online scientific congress of the European Society of Cardiology (ESC). The study also found that women with chest pain were more likely than men to wait over 12 hours before seeking medical help.

“Our findings suggest a gender gap in the first evaluation of chest pain, with the likelihood of heart attack being underestimated in women,” said study author Dr. Gemma Martinez-Nadal of the Hospital Clinic of Barcelona, Spain. “The low suspicion of heart attack occurs in both women themselves and in physicians, leading to higher risks of late diagnosis and misdiagnosis.”

This study examined gender differences in the presentation, diagnosis, The median age was 65 years in women and 59 years in men. Women were significantly more likely to present late to the hospital (defined as waiting 12 hours or longer after symptom onset): this occurred in 41% of women compared to 37% of men.

“This is worrying since chest pain is the main symptom of reduced blood flow to the heart (ischaemia) because an artery has narrowed,” said Dr. Martinez-Nadal. “It can lead to a myocardial infarction which needs rapid treatment.”

In the physician’s initial diagnosis, acute coronary syndrome was more likely to be considered the cause of chest pain in men compared to women. Specifically, in 93% of patients, the ECG did not provide a definitive diagnosis. In those patients, the doctor noted a probable acute coronary syndrome (ACS) in 42%

and management of patients admitted with chest pain to the chest pain unit of an emergency department between 2008 and 2019. Information was collected on risk factors for a heart attack including high blood pressure and obesity. The researchers recorded the physician’s initial diagnosis after the first evaluation of each patient, which is based on clinical history, physical examination, and an electrocardiogram (ECG) and occurs before other examinations like blood tests.

“We had the first impression of the doctor as to whether the chest pain had a coronary cause or another origin such as anxiety or a musculoskeletal complaint,” explained Dr. Martinez-Nadal.

A total of 41,828 patients with chest pain were included, of which 42% were women.