Factors affecting women’s participation in cardiovascular research: a scoping review

Abstract

Aims Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies. Methods and Results Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate. From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant and patient-specific factors including travel, childcare availability and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention. Conclusions This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women’s participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women’s participation in cardiovascular research. Registration The protocol was published on the public Open Science Framework (OSF) platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/.

Sex Disparities in Cardiovascular Disease

“…Barriers to participation included lack of information and understanding of the research, the women's lack of awareness of CVD as a significant risk, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, caregiving responsibility of women, childcare availability, and cost. 86 Regulatory agencies and medical organizations have taken steps to promote the inclusion of women in clinical research. For instance, the FDA released guidelines in 2014 encouraging the inclusion of more women in clinical trials.…”