Gender Disparities in Cardiac Surgery Trials: Leadership, Authorship, and Patient Enrollment

Abstract

Background: Studies have highlighted the paucity of women-led randomized controlled trials (RCTs) in cardiovascular medicine. Whether this finding also applies to cardiac surgery has not been evaluated. In this study, we evaluate women authorship, leadership, and women enrollment in cardiac surgery RCTs.

Methods: A systematic literature search was conducted to identify RCTs comparing 2 or more adult cardiac surgical procedures published from 2000 to 2022. Women-led RCTs were defined as those with a woman as either a first or last author. Linear regression and correlation analyses were used.

Results: Of 58 RCTs, 8 (13.8%) were women-led; 17 (29.3%) RCTs had no women authors. Overall, 17.9% of all authors were women, but only 1.2% of all authors were women cardiac surgeons and only 19% of the RCTs had a women cardiac surgeon among the authors. The median proportion of women authors was 14.3% by RCT, which was significantly higher in women-led compared with men-led RCTs (28.6% vs 11.8%; P = .01). No significant change in the proportion of women authors was observed during the study period. North American RCTs had a higher proportion of women authors compared with other geographic regions (28.6% vs 12.5%; P = .01). No correlation was found between the proportion of women authors and the proportion of women participants enrolled in individual RCTs.

Conclusions: During the last 2 decades, only a minority of cardiac surgery RCTs were women-led, and no significant increase in women authorship occurred. There are important geographic differences in women authorship.

Figure 1.

Proportion of women authors in cardiac surgery RCTs by year. P _{for trend} = 0.69. RCTs: randomized controlled trials.

Figure 2.

Comparison between women authors in cardiac surgery RCTs from North America and Europe by year. P for difference in slope = 0.22; P _{for trend} North America = 0.25; P _{for trend} Europe = 0.61. The gray areas represent the 95% CI for the regression lines. CI: confidence interval; RCTs: randomized controlled trials.

Figure 3.

Comparison between women authors in cardiac surgery RCTs from North America and all other regions by year. P for difference in slope = 0.36; P _{for trend} North America = 0.25; P _for trend all other regions = 0.61. The gray areas represent the 95% CI for the regression lines. CI: confidence interval; RCTs: randomized controlled trials.

Figure 4.

Correlation between proportion of women authors and proportion of women participants enrolled. The green area represents the 95% CI for the regression line (red). CI: confidence interval.