Systematic Incorporation of Sex‐Specific Information Into Clinical Practice Guidelines for the Management of ST‐Segment–Elevation Myocardial Infarction: Feasibility and Outcomes

BACKGROUND: Clinical practice guideline (CPG) developers have yet to endorse a consistent and systematic approach for considering sex‐specific cardiovascular information in CPGs. This article describes an initiative led by the Canadian Cardiovascular Society to determine the feasibility and outcomes of a structured process for considering sex in a CPG for the management of ST‐segment–elevation myocardial infarction. METHODS AND RESULTS: A sex and gender champion was appointed to the guideline development committee. The feasibility of tailoring the CPG to sex was ascertained by recording (1) the male–female distribution of the study population, (2) the adequacy of sex‐specific representation in each study using the participation/prevalence ratio, and (3) whether data were disaggregated by sex. The outcome was to determine whether recommendations for CPGs based on an assessment of the evidence should differ by sex. In total, 175 studies were included. The mean percentage of female participants reported in the studies was 24.5% (SD: 6.6%; minimum: 0%; maximum: 51%). The mean participation/prevalence ratio was 0.62 (SD: 0.16; minimum: 0.00; maximum: 1.19). Eighteen (10.2%) studies disaggregated the data by sex. Based on the participation/prevalence ratio and the sex‐specific analyses presented, only 1 study provided adequate evidence to confidently inform the applicability of the CPG recommendations to male and female patients. CONCLUSIONS: Implementing a systematic process for critically appraising sex‐specific evidence for CPGs was straightforward and feasible. Inadequate enrollment and reporting by sex hindered comprehensive sex‐specific assessment of the quality of evidence and strength of recommendations for a CPG on the management of ST‐segment–elevation myocardial infarction.