Under-Representation of Women Authors in Heart Failure Trials

Quick Takes

  • Women are under-represented as key (leading, senior, or corresponding) authors in HF clinical trials, and there has been no temporal change over 20 decades.
  • Men comprise approximately 84-89% of lead, senior, and corresponding authors in HF RCTs.
  • Lack of women authorship in HF RCTs reflects the disparity in mentorship, inclusion, and leadership roles in academic medicine.

Study Questions:

How well are women represented as authors in heart failure (HF) randomized controlled trials (RCTs)?


A systematic review of HF clinical trials published in English between January 1, 2000 and May 7, 2019 was performed. Studies were screened for eligibility. Descriptive analysis was performed and multivariable logistic regression was used to determine characteristics associated with women as lead authors.


Of 10,596 manuscripts, 403 were ultimately eligible for inclusion. The 403 trials were authored by 4,346 authors (median 10 authors) and mostly conducted in Europe (54.3%). Women comprised 19.6% of all authors. Men were lead authors in 84.4%, senior authors in 87.1%, and corresponding author in 88.6%. Women comprised 12.1% and 14.3% of lead and senior authors of multicenter trials, 1.2% and 0.5% of lead and senior authors of device trials, and 8.7% and 7.9% of lead and senior authors of drug trials. Women had lower odds of lead authorship in RCTs that were multicenter (odds ratio [OR], 0.58), had men as senior authors (OR, 0.5), tested drug interventions (OR, 0.42), or coordinated in North America (OR, 0.21) or Europe (OR, 0.33). The proportion of women authors in any position did not change significantly over time, and the proportion of women authors as lead, senior, or corresponding author decreased, but not significantly, over time.


Women are under-represented in key authorship positions in HF clinical trials with no change in temporal trends.


Women are under-represented as authors and specifically, as key authors, in HF clinical trials. This may reflect the more pervasive problems of under-representation and lack of inclusion and mentorship of women in academic medicine, and may ultimately contribute to the under-representation of women in clinical trials. Recognizing and addressing disparities may improve gender balance in academic medicine and in clinical trials.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Authorship, Healthcare Disparities, Heart Failure, Mentors, Publications, Randomized Controlled Trials as Topic, Women

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