Evidence map›Paper›PMID 40889952›Full record

SynthesisOpen heart2025

Representation of women in cardiovascular disease management: a systematic analysis of ESC guidelines.

S Samaneh Lashkarinia, Angela W C Lee, Tiffany M G Baptiste, Rosie K Barrows, Charles P Sillett, Cristobal Rodero, Upasana Tayal, Antonio de Marvao, Nicholas Panay, Catherine Williamson and 6 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing 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

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

  1. Pooled it
  2. Review
  3. Review
  4. Cardiovascular imaging in women: from diagnostic bias to inclusive cardiovascular science.European heart journal. Imaging methods and practice · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

S Samaneh LashkariniaImperial College London, London, UK.ORCID http://orcid.org/0000-0002-9731-7199
Angela W C LeeImperial College London, London, UK.
Tiffany M G BaptisteKing's College London, London, England, UK.
Rosie K BarrowsKing's College London, London, England, UK.
Charles P SillettKing's College London, London, England, UK.
Cristobal RoderoImperial College London, London, UK.
Upasana TayalGuy's and St Thomas' NHS Foundation Trust, London, England, UK.
Antonio de MarvaoKing's College London, London, England, UK.
Nicholas PanayDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Catherine WilliamsonDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Carina Blomstrom-LundqvistDepartment of Cardiology, Örebro University, Örebro, Sweden.
Kristina HaugaaDepartment of Cardiology, Oslo University Hospital, Oslo, Oslo, Norway.ORCID http://orcid.org/0000-0002-4900-0453
Barbara CasadeiImperial College London, London, UK.
Mary M MaleckarDepartment of Cardiology, Oslo University Hospital, Oslo, Oslo, Norway.
Marina StrocchiImperial College London, London, UK.
Steven A NiedererThe Alan Turing Institute, London, England, UK s.niederer@imperial.ac.uk.

Funding

Using Atrial Mechanics To Identify Fibrosis In Patients with Atrial FibrillationR01HL152256 · NHLBI · STANFORD UNIVERSITY · PI ENNIS, DANIEL B · 2020 to 2023
$2.8M
NHLBI NIH HHS R01 HL152256
6 · The paper itself

Abstract

objectiveSex differences play a critical role in the presentation, progression and treatment outcomes of cardiac diseases. However, historical male predominance in clinical studies has led to disparities in evidence supporting care for both sexes. Clinical guidelines are essential for cardiovascular care, shaping practice and influencing patient outcomes. In this study, we reviewed 34 European Society of Cardiology (ESC) guidelines between 2002 and 2024 to evaluate the representation of women and the inclusion of female-specific recommendations.

methodsWe compiled 136 gender-related keywords, validated by six clinicians, and quantified their occurrence across guidelines. While our primary analysis focused on female-specific keywords, we also identified male-specific terms as a comparison point to help quantitatively interpret the representation of female-specific terminology in the guidelines. Each guideline underwent independent review by two auditors who used structured questions to assess its sensitivity to female-specific differences in disease presentation, diagnosis, management and treatment.

resultsThe most frequent terms were 'pregnancy', 'women' and 'sex', with 1768 (17.9%), 1573 (15.9%) and 676 (6.8%) overall repetitions, respectively, contrasted against 'cardiac' (6932 occurrences) as a baseline. Results showed inconsistency in addressing female-specific factors and health considerations in ESC guidelines. We were able to assess the relative frequency of female-specific language and highlight in contrast areas where female representation in cardiovascular guidelines may be insufficient. Most guidelines (24/34) mentioned pregnancy and provided related recommendations, with one of the guidelines entirely dedicated to cardiovascular disease (CVD) in pregnancy (2018) and a new one planned for 2025. Only 10/30 guidelines acknowledged menopause as a CVD risk factor and offered recommendations for clinical practice.

conclusionsThese findings highlight the need for systematic integration of female-specific considerations across all guidelines. In the wider context, there is also a need for improved representation of women in clinical trials and for making the available evidence on which the guidelines are based less biased toward men.

Indexed as

CardiologyCardiovascular DiseasesDisease ManagementHealthcare DisparitiesPractice Guidelines as TopicSocieties, MedicalEuropeFemaleHumansMaleSex FactorsDelivery of Health CareOutcome Assessment, Health CareQuality of Health CareWomen

Identifiers

PMID40889952
PMCPMC12406885

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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 Socratic graph.