Gender Differences in International Cardiology Guideline Authorship: A Comparison of the US, Canadian, and European Cardiology Guidelines From 2006 to 2020

Abstract

Background Women continue to be underrepresented in cardiology and even more so in leadership positions. We evaluated the trends and gender differences in the guideline writing groups of the American College of Cardiology/American Heart Association (ACC/AHA), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC) guidelines from 2006 to 2020. Methods and Results We extracted all guidelines authors from 2006 to 2020, assessed their gender from publicly available profiles, and compared differences based on subspecialties and specific societies. Stratified and trend analyses were performed using χ 2 and average annual percentage change/average 5 year percentage change. A total of 80 ACC/AHA (1288 authors [28% women]), 64 CCS (988 authors [26% women]), and 59 ESC (1157 authors [16% women]) guidelines were analyzed. A significant increase in inclusion of women was seen in ACC/AHA (12.6% [2006] to 42.6% [2020]; average annual percentage change, 6.6% [2.3% to 11.1%]; P =0.005) and ESC (7.1% [2006] to 25.8% [2020]; average annual percentage change, 6.6% [0.2% to 13.5%]; P =0.04), but the trend remained similar in CCS (20.6% [2006] to 36.3% [2020]; average annual percentage change, −0.1% (−3.7% to 3.5%); P =0.94), guideline authors. More women were coauthors in the ACC/AHA and ESC guidelines when women were chairs of guidelines. There was a persistent disparity of women among guideline authors for general cardiology and all subspecialties, except for pediatric cardiology and heart failure guidelines. The appointment of women authors as a chair was significantly low in all societies (22.4% [ACC/AHA], 16.9% [CCS], and 7.2% [ESC]; P =0.008). Conclusions There is a significant disparity in the inclusion of women on all national guideline committees, in addition to serving as a chair of cardiology guidelines. Further advocacy is required to promote equity, diversity, and inclusion in our cardiology guidelines globally.

Women physicians in cardiovascular magnetic resonance: Past, present, and future

“…Significant gender inequity persists when it comes to compensation. Female cardiologists continue to earn, on average, $32,000 less than male cardiologists in both private practice and academia, even after controlling for location, subspecialty, and full-time status ( 65 , 66 , 69 ). This disparity in earnings is exacerbated by the cost of children, both in fewer work hours or hired child care: either women are predominantly responsible for looking after their children (and thus not able to work and earn), or they must arrange paid childcare, which will cost around 11–20% of their salary ( 44 , 53 , 56 ).…”

“…Women have significantly lower rates of the first authorship, particularly in high-impact journals, and are cited less often (60)(61)(62)(63). Female cardiologists are often neither involved in the high-impact trials nor on the writing committees of clinical guidelines (64)(65)(66). Women in academia also have less success in career development awards, with gender differences persisting in a number of awards for clinician-researchers in the US, even when adjusting for confounders (67).…”

Women Authorship in Cardiovascular Science: A Call to Track and Report to Achieve Equity

“…In this issue of the Journal of the American Heart Association (JAHA) , Rai et al report longitudinal trends in women authors of cardiology guidelines from 2006 to 2020. 2 The authors evaluated North American guidelines (from the American College of Cardiology/American Heart Association [ACC/AHA] and Canadian Cardiovascular Society) and European guidelines (from the European Society of Cardiology). From dozens of guidelines, findings revealed that among 1288 authors of ACC/AHA guidelines, 28% were women, whereas among 988 Canadian Cardiovascular Society authors, 26% were women, and among 1157 European Society of Cardiology authors, only 16% were women.…”

Mentorship and the Leaky Pipeline in Academic Cardiology

“…4 More than half of cardiovascular trials in the last decade had a leadership structure entirely devoid of female physicians, and only 26% of cardiology practice guideline authors were women. 5 , 6 These statistics explain in large part our failures to effectively recruit representative study cohorts in our clinical trials and to equitably translate research advances into improved population health. The lack of representative data delays adoption of potentially life-prolonging or enhancing treatment strategies and inflicts harm when therapeutics are used without evidence of safety.…”