Bridging the Gap: Advancing Equity in Women's Heart Surgery

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Health Equity Monthly Focus
By Molly Schultheis, MD, cardiothoracic surgeon

Heart disease is the leading cause of death for women in the United States, yet for decades, the research guiding our treatment strategies has been based mostly on studies of men. Two years ago, I became interested in gender equity within my field after reading an article in JAMA that discussed how women remain at higher risk for poor outcomes after coronary artery bypass grafting (CABG) with no significant improvement over the last decade. This inspired my participation in the ROMA: Women Trial, the first female-only open heart surgery randomized trial in the world.

CABG, also known as bypass surgery, is used to improve blood flow to the heart. The graft uses blood vessels from other parts of the body, such as the arm, chest, or leg, to bypass the blockage in the artery. Traditionally, studies on CABG techniques have been based on surgeries on men or studies including both men and women.

Sponsored by Weill Medical College of Cornell University, the ROMA: Women study aims to compare two methods of performing CABG in women. The study investigators are assessing the impact these methods have on heart health, quality of life, and symptoms in different subgroups. Understanding how women’s physiology uniquely responds to procedures used to restore blood flow is incredibly important as we focus on continuously improving outcomes for women with heart disease.

Research Beyond ROMA

Beyond my involvement in ROMA: Women, I have expanded my research efforts to address additional inequities. I am actively engaged in the RECHARGE trial, which compares percutaneous coronary intervention (PCI) and CABG in women, Black, and Hispanic patients—populations historically underrepresented in cardiac surgery research. Additionally, I am starting my own research trial analyzing the arteries and veins used for grafting in CABG on a microscopic level. My hope is that these studies will pave the way for more personalized, equitable treatment strategies that improve long-term outcomes for all patients.

Overcoming Barriers in Research

One of the challenges in conducting this research is patient participation. Many patients understandably want to follow existing guidelines, which are largely based on studies of white men. However, I remind them that our goal is to generate data specifically on minority populations so we can improve their outcomes. Without their participation, we cannot close the knowledge gap that has persisted for far too long.

A New Perspective on Medicine and Health Equity

I have always had a passion to take care of patients and give them a better quality of life and increased survivability. With my new involvement in minority research, I have found a new way to interweave my work in the operating room with my contribution to health equity. My research contribution has made me appreciate how much we still need to learn in future studies to close the gender and minority gap in cardiovascular outcomes. The more we learn, the better we can tailor our treatments, ensuring that every patient—regardless of gender or race—receives the best possible care.