Representation of Women Authors in International Heart Failure Guidelines and Clinical Trials

This observational analysis examined 118 publications (guideline citations and clinical trials) to characterize the proportion of women authors in heart failure guidelines from U.S. and European societies and in contemporary heart failure clinical trials, and to test whether women authorship correlated with women’s enrollment in those trials.

Women comprised a median of 20% of authors in U.S. guidelines, 14% in European guidelines, and only 11% in heart failure clinical trials. Women’s authorship increased modestly over time in guidelines but showed no trend in trials. Trials led by women investigators had significantly higher enrollment of women participants.

The correlation between women authorship and women’s enrollment is the most clinically relevant finding. Under-representation of women in trials produces evidence bases that may not generalize to female patients — a recognized problem across cardiology but particularly acute in heart failure, where women have different risk factors, presentations, and responses to therapy than men.

This paper is at the margins of the core CAD research base — focused on heart failure rather than coronary disease, and measuring authorship demographics rather than clinical outcomes. However, the broader issue it addresses (gender disparity in trial enrollment generating evidence gaps in female cardiovascular patients) is directly relevant to coronary disease management.

We rate the evidence limited. A descriptive observational analysis of authorship representation in heart failure research — important for health equity context, but primarily a measure of research process rather than clinical outcomes.