Female representation in interventional cardiology remains low, but there is cause for hope

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Suzanne Baron and Ki Park

Suzanne Baron and Ki Park detail some of the barriers facing women in the field of interventional cardiology, and consider some of the potential solutions to better representation in the field.

Many female interventional cardiologists tell the story of being the only woman in their interventional fellowship or the only female physician in the catheterisation laboratory at their institution. Unfortunately, this narrative extends beyond just anecdotes. Indeed, despite 50% of medical students being women, the proportion of females in cardiology and cardiology sub-specialties remains low with only 14.9% of practicing cardiologists identifying as women1. The number becomes even more dismal when one looks at the percentage of practicing interventional cardiologists who are female —a mere 8%1, and the numbers decline even further when assessing gender diversity of structural operators2.

The aetiology for such poor gender representation amongst interventional cardiologists appears to be multifactorial. Yong and colleagues surveyed 574 cardiology fellows in an attempt to identify those factors that may affect a trainee’s decision to pursue a career in interventional cardiology3. Compared with males, females were significantly more likely to be deterred from interventional cardiology due to concerns regarding radiation exposure during childbearing years, sex discrimination and harassment, an “old boys club” culture, and a lack of female interventional role models. Coupled with the well documented disparities in salary and academic advancement between male and female cardiologists4, it is not surprising that women remain sorely underrepresented in the interventional cardiology sphere.

Recruiting more women into the field of interventional cardiology is important not just to improve diversity, but also to potentially address sex-specific disparities in patient care. Studies have shown that female patients with a wide variety of cardiovascular conditions tend to be under-diagnosed, under-treated and have worse outcomes when compared with men5–7. Additionally, there are several female-specific or female-predominant cardiac disease entities (e.g. coronary microvascular dysfunction, MINOCA [myocardial infarction in non-obstructive coronary arteries], spontaneous coronary artery dissection), which have been historically under-recognised8,9. While there are many contributing factors to these disturbing trends, the historically low enrolment of women in cardiology trials has likely contributed to a poorer understanding of the best methods to diagnose and treat women with cardiac disease10. Since some studies have suggested that physician-patient gender concordance may influence outcomes11, it is possible that increasing female representation in the field of cardiology, both at the patient-provider level as well as in clinical trial leadership, may translate to improved patient care through increased female participation in clinical trials and through a better understanding of disease presentation and management of the female patient.

The gender imbalance within interventional cardiology and cardiology in general has been recognised over the last several years, due in no small part to a handful of iconic female trailblazers in cardiology, who have shown a bright light on this issue. With this recognition has come the growth of formal women’s groups and mentorship programs within national cardiology societies (e.g. Society for Cardiovascular Angiography and Interventions—Women In Innovations; American College of Cardiology—Women In Cardiology), increased involvement of female cardiologists as faculty at conferences, greater education on radiation safety in the catheterisation lab, and industry commitment to improve involvement of women in clinical trials, both at the patient and physician level. And these efforts appear to be bearing fruit as evidenced by the fact that the pipeline is expanding—13% of US interventional cardiology trainees were women in 2019—a 50% increase from 2015 (1,12). While these statistics are certainly encouraging, the absolute numbers are modest, thereby underscoring the fact that much work remains to be done. Indeed, improving female representation within the ranks of cardiology will require a continued focus from academic institutions, industry and national societies alike, for it is only with this communal effort that the true benefits of gender diversity can be recognised for our patients.

Suzanne Baron is an interventional cardiologist specialising in structural heart interventions and the director of interventional cardiology research at Lahey Hospital and Medical Center, Burlington, USA.

Ki Park is an associate professor of Medicine in the Division of Cardiovascular Medicine at the University of Florida, Gainesville, USA.

References
1. Association of American Medical Colleges. Physician Specialty Data Report Washington, DC, 2020.
2. Simpson TF, Atkinson TM, Chadderdon S et al. Gender Disparity Among Transcatheter Aortic Valve Replacement Operators in the United States. Circ Cardiovasc Interv 2021;14:e010659.
3. Yong CM, Abnousi F, Rzeszut AK et al. Sex Differences in the Pursuit of Interventional Cardiology as a Subspecialty Among Cardiovascular Fellows-in-Training. JACC Cardiovasc Interv 2019;12:219-228.
4. Jagsi R, Biga C, Poppas A et al. Work Activities and Compensation of Male and Female Cardiologists. J Am Coll Cardiol 2016;67:529-41.
5. Bugiardini R, Ricci B, Cenko E et al. Delayed Care and Mortality Among Women and Men With Myocardial Infarction. J Am Heart Assoc 2017;6.
6. Skelding KA, Boga G, Sartorius J et al. Frequency of coronary angiography and revascularization among men and women with myocardial infarction and their relationship to mortality at one year: an analysis of the Geisinger myocardial infarction cohort. J Interv Cardiol 2013;26:14-21.
7. Dewan P, Rorth R, Jhund PS et al. Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women. J Am Coll Cardiol 2019;73:29-40.
8. Hayes SN, Kim ESH, Saw J et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 2018;137:e523-e557.
9. Berry C, Duncker DJ. Coronary microvascular disease: the next frontier for Cardiovascular Research. Cardiovasc Res 2020;116:737-740.
10. Cho L, Vest AR, O’Donoghue ML et al. Increasing Participation of Women in Cardiovascular Trials: JACC Council Perspectives. J Am Coll Cardiol 2021;78:737-751.
11. Lau ES, Hayes SN, Volgman AS et al. Does Patient-Physician Gender Concordance Influence Patient Perceptions or Outcomes? J Am Coll Cardiol 2021;77:1135-1138.
12. Association of American Medical Colleges. Physician Specialty Data Report. Washington, DC, 2016.


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