Another ongoing challenge is the fact that women tend to have more day-to-day burdens related to “childcare and family responsibilities,” making it harder for them to agree to the long-term commitments associated with clinical trial participation following PCI or CABG.

“Although some trials reimburse patients, this is often insufficient to cover both the actual and the opportunity costs associated with participation, leading to additional disproportionate barriers,” Yong and Fearon wrote. “Even when this is not the case, implicit bias may lead to the perception that a female candidate may not be appropriate. More research to understand the perspectives of women patients and their practitioners is needed.”

The two co-authors noted that changes in clinical trial leadership have been associated with improved patient representation. However, with the percentage of women in interventional cardiology being as low as 5% by some calculations, getting enough women in leadership positions to truly make an impact could quite the struggle. Also, simply waiting for more women to get involved so that more women can be recruited is not enough—to truly make a difference, clinical trial leaders must truly make equal representation a priority. This means accepting a recruitment period that is longer than average when necessary, Young and Fearon wrote, or exploring if artificial intelligence could potentially make an impact.

“Instituting these outcomes-based measures will only be successful if all stakeholders across the clinical trial spectrum are aligned, ranging from funders to journal editorial boards to trialists to clinicians and their patients,” the duo concluded. “If together we do not just hope for, but demand, adequate representation as a necessary criterion for high-quality studies worthy of adoption into practice, we will have a real shot at achieving true equity in our trials.”

Read the full editorial in JAMA Cardiologyhere.