Division of Cardiovascular Medicine (N.R.), Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.S.T., A.A., A.H.H.).
Circ Heart Fail. 2020 Aug;13(8):e006605. doi: 10.1161/CIRCHEARTFAILURE.119.006605. Epub 2020 Aug 6.
Gender disparities in authorship of heart failure (HF) guideline citations and clinical trials have not been examined.
We identified authors of publications referenced in Class I Recommendations in United States (n=173) and European (n=100) HF guidelines and of publications of all HF trials with >400 participants (n=118) published between 2001 and 2016. Authors' genders were determined, and changes in authorship patterns over time were evaluated with linear regression and nonparametric testing.
The median proportion of women authors per publication was 20% (interquartile range [IQR], 8%-33%) in United States guidelines, 14% (IQR, 2%-20%) in European guidelines, and 11% (IQR, 4%-20%) in HF trials. The proportion of women authors increased modestly over time in United States and European guidelines' references (β=0.005 and 0.003, respectively, from 1986 to 2016; <0.001) but not in HF trials (12.5% [IQR, 0%-20%] in 2001-2004 to 8.9% [IQR, 0%-20%] in 2013-2016; >0.50). Overall proportions of women as first or last authors in HF trials (16%) did not change significantly over time (=0.60). North American HF trials had the highest likelihood of having a woman as first or senior author (24%). HF trials with a woman first or senior author were associated with a higher proportion of enrolled female participants (39% versus 26%, =0.01).
In HF practice guidelines and trials, few women are authors of pivotal publications. Higher number of women authors is associated with higher enrollment of women in HF trials. Barriers to authorship and representation of women in HF guidelines and HF trial leadership need to be addressed.
心力衰竭（HF）指南引用和临床试验中的作者性别差异尚未得到研究。
我们确定了美国（n=173）和欧洲（n=100）HF 指南中 I 类推荐出版物参考文献以及所有 HF 试验（n=118）的出版物作者，这些试验的参与者人数均超过 400 人，时间跨度为 2001 年至 2016 年。确定了作者的性别，并通过线性回归和非参数检验评估了随时间变化的作者模式。
美国指南中，每篇出版物的女性作者中位数比例为 20%（四分位距[IQR]，8%-33%），欧洲指南中为 14%（IQR，2%-20%），HF 试验中为 11%（IQR，4%-20%）。美国和欧洲指南参考文献中女性作者的比例随时间略有增加（1986 年至 2016 年分别为 0.005 和 0.003，<0.001），但 HF 试验中没有增加（2001-2004 年为 12.5%[IQR，0%-20%]，2013-2016 年为 8.9%[IQR，0%-20%]；>0.50）。HF 试验中女性作为第一或最后作者的总体比例（16%）随时间变化不显著（=0.60）。北美 HF 试验中女性作为第一或资深作者的可能性最高（24%）。HF 试验中女性作为第一或资深作者与女性参与者的比例较高相关（39%比 26%，=0.01）。
在 HF 实践指南和试验中，很少有女性是关键出版物的作者。更多的女性作者与 HF 试验中更多的女性参与者相关。需要解决 HF 指南和 HF 试验领导层中作者和女性代表性的障碍。
