Evidence map›Paper›PMID 38405270›Full record

ArticleJACC. Advances2024

Underrepresentation of Women in Reduced Ejection Heart Failure Clinical Trials With Improved Mortality or Hospitalization.

Eson Ekpo, Sujana Balla, Summer Ngo, Celeste Witting, Ashish Sarraju, Adam Furst, Fatima Rodriguez

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Advances, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Observational
  7. Article
  8. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Eson EkpoDepartment of Cardiovascular Medicine, Scripps Clinic, La Jolla, California, USA.
Sujana BallaDepartment of Internal Medicine, University of California-San Francisco, Fresno, California, USA.
Summer NgoDivision of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.
Celeste WittingDepartment of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Ashish SarrajuDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Adam FurstDivision of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.
Fatima RodriguezDivision of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.

Funding

Adherence Determinants in the Health Electronic Record Evaluation of Statins (ADHERES)R01HL168188 · NHLBI · STANFORD UNIVERSITY · PI Fatima Rodriguez · 2024 to 2026
$2.1M
SURPASS: (Statin Use and Risk Prediction of Atherosclerotic Cardiovascular Disease in minority Subgroups)K01HL144607 · NHLBI · STANFORD UNIVERSITY · PI RODRIGUEZ, FATIMA · 2019 to 2023
$856k
NHLBI NIH HHS K01 HL144607NHLBI NIH HHS R01 HL168188
6 · The paper itself

Abstract

backgroundThere are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), influence current guidelines for therapy.

objectivesThe authors evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF.

methodsWe queried Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). A PPR of 0.8 to 1.2 was considered representative.

resultsThe final analysis included 33 RCTs. Women represented only 23.2% of all enrolled participants (n = 24,366/104,972), ranging from 11.4% to 40.1% per trial. Overall PPR was 0.58, with per-trial PPR estimates ranging from 0.29 to 1.00. Only 5 trials (15.2%) had a PPR of women representative of the disease population. Representation did not change significantly over time. The proportion of women in North American trials was significantly greater than trials conducted in Europe (

conclusionsWomen are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits and influence current guidelines. Representation is key to further delineation of sex-specific differences in major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.

Indexed as

heart failureheart failure reduced ejection fractionrepresentationwomen

Identifiers

PMID38405270
PMCPMC10890822

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.