Women “underrepresented” in heart failure studies

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Lead author Nosheen Reza

Representation of women leading heart failure research remains limited, according to a study published in Circulation: Heart Failure, which may create a barrier to greater diversity among clinical trial participants.

The analysis, which was led by Nosheen Reza, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA, showed that that less than 20% of first authors on manuscripts cited to support the highest recommendations in heart failure treatment guidelines were women, and less than 15% of the senior authors were women. Furthermore, only 16% of contemporary clinical trials in heart failure had a woman as a first or senior author.

Despite this lack of representation in authorship, researchers found that clinical trials with higher proportions of women authors had a higher number of female participants.

“Diversity in authorship can have a snowball effect across the field—not only in improving gender equity in cardiovascular medicine, but also perhaps in reducing the underrepresentation of women in clinical trials,” said Reza. “For many reasons, institutions are now taking a hard look at improving diversity, inclusion, and equity, and our findings represent benchmarking data that organisations can utilise and build from.”

The researchers identified authors of publications referenced in class I recommendations—representing the strongest clinical guidelines and recommendations—in the US (173) and European heart failure guidelines (100), and of publications of heart failure trials with more than 400 participants published between 2001 and 2016 (118). After authors’ genders were determined by using a multinational database and name matching algorithm, the researchers evaluated the authorship patterns—with a focus on those who led the research for each paper—over time.

On average, the overall proportions of women as first authors of referenced publications in the US heart failure guidelines was 18% and 16% for European heart failure guidelines, and as last authors 13% and 12%, respectively. From 1986 to 2016, the percentage of women authorship modestly increased overall in guideline citations, the study team found.

The proportions of women as first or last authors in heart failure clinical trials did not change significantly over time, and only 16% of the heart failure clinical trials examined had a woman as a first or senior author. However, heart failure trials with a woman first or senior author were associated with a higher proportion of enrolled female clinical trial participants (39% vs. 26%).

“While the reasoning behind this interesting phenomenon is still unknown, it’s clear representation is an important element for improving care for women,” Reza said. “One hypothesis we have for this finding is that women may be more likely to enrol as participants in clinical trials that they know are being conducted by women investigators. Another possibility could be that women investigators are more likely to refer women patients for enrolment in clinical trials. This is certainly an area in which future research is needed.”

The authors call for efforts to rectify these disparities, especially since women authorship of heart failure clinical trials is an important predictor of the enrolment of female participants, which may help to reduce the underrepresentation of women in heart failure clinical trials.

“Institutions must come together to make a committed effort to improve diversity, inclusion, and equity on promotions committees, editorial boards, steering committees, and other leadership bodies in the heart failure research enterprise. Women will not overcome these hurdles if these metrics and efforts don’t change. By advocating for broad scale efforts in these domains, such as including more women in leadership positions and increasing the mentorship of women across career stages in medicine, we’ll be able to develop future generations of experienced and accomplished women investigators and mentors in heart failure, and advance science together without leaving anyone behind,” Reza said.


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