Attack of the clones? Cardiology journals multiply in 2008

May 13, 2008


Dallas, TX and Washington, DC - There are hundreds of scientific journals for cardiologists, from Acta Cardiologica to Zhonghua Xin Xue Guan Bing Za Zhi (Chinese Journal of Cardiovascular Diseases). Eight more have been added or are expected to launch this year. Few doubt they will be of the highest quality or expect them to fall short on submissions, but some wonder about the timing and motivation behind the bimonthly avalanche of new paper from the often-allied, frequently competing American Heart Association (AHA) and American College of Cardiology (ACC).

Some have also questioned the need for all of the new journals, spinoffs of the two society flagships Circulation and Journal of the American College of Cardiology (JACC) that focus on specialized areas such as cardiac imaging and coronary interventions, especially given the cadre of smaller cardiology publications that routinely publish manuscripts rejected by the larger, broad-based journals.

Behind closed doors, heart wire has learned from several sources who asked not to be quoted, some journal editors have expressed annoyance, even anger, at the threat they perceive to their publications as the new ones take possession of manuscripts and advertising that might have gone to them. Others appear content to wait and see.

There's going to be a point when people will just simply say, I just can't read them all.

Much of any animosity appears directed at the AHA, which unveiled plans for its slate of six new titles after—some say in response to—an ACC announcement that it would introduce two specialized publications under the JACC name. Both have directly competing counterparts among the new Circulation journals, furthering the perception that the latter are something like return fire in a cold war for influence in cardiology.

Others observe that all eight new journals, with the parent publications' prestige behind them, are likely to be, perhaps even intended to be, moneymakers for the AHA and ACC.

However, public statements from the journals' editors and as well as observers have generally been diplomatic, supportive, and even optimistic about the new abundance of journals, downplaying any hints of political struggle.

Experiments in publishing

Can the field of cardiology publications support a cardiac electrophysiology title more specialized than cardiac EP itself?

The peer-reviewed open-source Journal of Atrial Fibrillation, introduced in May and nicknamed JAFIB on its website, recently released its second issue. Dr Andrea Natale (Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin) is at the journal's helm as editor-in-chief.

"Open source" means, among other things, that its content is available to anyone free of charge, "an attempt to challenge the conventional scholarly publishing model, with the aim to make knowledge free for all," the journal's site explains. The number of such journals is on the rise, yet they remain an experiment in publishing.

A question of need

Publicly, the story began in early 2007, when JACC editor-in-chief Dr Anthony N DeMaria (University of California, San Diego) announced that his publication would beget two more narrowly focused journals[1]. JACC: Cardiovascular Imaging launched on schedule in January of this year, followed the next month by JACC: Cardiovascular Interventions.

[Source American College of Cardiology. Used with permission]

And in November 2007, Circulation editor-in-chief Dr Joseph Loscalzo (Brigham and Women's Hospital, Boston, MA) announced the impending arrival of its six new journals [2], the first of which, Circulation: Arrhythmia and Electrophysiology, was released in April. The launch of Circulation: Heart Failure is expected soon, while Circulation: Cardiovascular Interventions and Circulation: Cardiovascular Outcomes and Quality are scheduled for midsummer release and the introduction of Circulation: Cardiovascular Genetics and Circulation: Cardiovascular Imaging is set for the fall.

"I don't think they're really necessary," said's editor-in-chief Dr Eric Topol (Scripps Translational Science Institute, La Jolla, CA) in an installment of his video blog TopoLog shortly after the AHA announced its new publications in November 2007 [3]. In it, Topol draws a distinction between Nature's successful spawning of its broad specialty publications such as Nature Medicine and Nature Genetics and the spinoffs from Circulation and JACC. The latter are already subspecialty journals, with less opportunity for meaningful subdivision of topics, whereas the purview of Nature is as broad as its name suggests. He also asked viewers whether they think a "war for dominance" between Circulation and JACC might be what's really behind the new journals.

Dr William C Roberts

"It was a big deal in 1982 when the [ACC] decided to start its own journal. Suddenly there were four US cardiology journals rather than three, I mean major ones," said Dr William C Roberts (Baylor University Medical Center, Dallas, TX), longtime editor of the American Journal of Cardiology (AJC), which until then had been the ACC's official journal. "At that time, there was no doubt it was needed," he told heart wire . The number of manuscripts for publication was exploding. Over the next five years, Roberts observed, submissions to the AJC doubled, even with the young JACC to bear some of the load along with the already-established Circulation and American Heart Journal.

Submissions from abroad accounted for much of the growth, according to Roberts. By 1995, half of papers submitted to the AJC were from outside the US; last year, he said, they represented about two-thirds of the journal's approximately 3200 submissions.

So far in 2008, Roberts said, the journal is on track to surpass last year's record number, but "I don't know how these new journals are going to affect that."

On the AJC's editorial board, he said, some members believe the journal will take a hit from the ACC and AHA entries as they absorb more of the available manuscripts; other members say they don't believe there will be any fallout. "None of us know for sure at the moment," Roberts said, but with eight new journals generated in six months out of 12, "I think one can flood a market and hurt everybody."

The prospect of competing with Circulation's journal on heart failure has already had a limited impact on the Journal of Cardiac Failure, according to its editor, Dr Barry M Massie (University of California and Veterans Affairs Medical Center, San Francisco). It had recently been partly behind his putting a hold on plans to expand the journal from its current 10 issues per year, he told heart wire .  But submissions have continued to increase, he said, "so we almost certainly will go to 12 issues next year after all."

Dr Eric N Prystowsky

Dr Eric N Prystowsky (The Care Group, Indianapolis, IN) is editor of the Journal of Cardiac Electrophysiology (JCE), one of the publications—along with the Heart Rhythm Society journal Heart Rhythm—that now compete with the newcomer Circulation: Arrhythmia and Electrophysiology . "I think adding another [EP] journal is going to make life harder for people who try to keep up. Before, they'd look in Circulation but now they also have to look in 'Circ EP.' There's going to be a point when people will just simply say, I just can't read them all," he said to heart wire .

"There's no question, both Heart Rhythm and JCE will suffer somewhat, because until now, an article rejected at Circulation may have come right to us as a second choice," according to Prystowsky. "Now there is a feeder system from Circulation to 'Circ EP,' and I'm sure that some of those articles [that would have gone to us] will be siphoned off."

But it's too early to tell how much effect the Circulation EP journal will have on JCE, he said. "Right now we're inundated. From January to April, we had more submissions than we did last year at this time. And there's been a steady rise in submissions over the past four years. That does not mean that a year from now we won't be affected by this move at Circulation, because I think we will, somewhat."

Rationale for new publications: The official word

Statements from editors of the AHA- and ACC-sponsored journals are upbeat about the need for their new charges and the role they expect them to play in cardiology.

Dr David D Gutterman

Dr David D Gutterman (Medical College of Wisconsin, Milwaukee) chair of the AHA Scientific Publishing Committee, described the organization's reasoning for introducing the new journals. In general, he told heart wire , submissions to all of the AHA's journals have been on the rise, and Circulation had been accepting only 10% to 12% of the articles submitted to it. "There are a large number of [submitted] articles that are of very high caliber, need to be disseminated, and are worthy of publication that just don't quite fit the general cardiology focus in Circulation," even though they otherwise meet the journal's standards, according to Gutterman. Rejected by Circulation, typically they are published elsewhere, he said. "The goal was to create additional journals of very high quality to publish those within the American Heart Association."

Loscalzo similarly commented in his editorial, "Although we certainly do not need more journals of average or lesser quality, the field can definitely benefit from additional subspecialty journals of the very highest quality."

The AHA already publishes the journals Hypertension and Stroke as well as Circulation Research and Arteriosclerosis, Thrombosis, and Vascular Biology in addition to the flagship publication.

I don't believe there are high-quality articles that aren't being published in existing journals, honestly.

DeMaria's rationale, at least in his public statements, mirrors that of the AHA. When announcing the new ACC journals last year, he wrote that submissions to JACC were climbing while its acceptance rate had gradually fallen below 15%. JACC frequently rejects "manuscripts of considerable merit, just because they do not achieve sufficient priority for our limited pages," he wrote. "Thus, many quality papers exist that are available as content for new journals," with the fast-changing fields of imaging and coronary intervention identified as likely areas of need.

[Note: Loscalzo declined to be interviewed for this story. Attempts to reach DeMaria were unsuccessful.]

"We were seeing a great many good papers on interventional topics coming to JACC, and we were accepting only one in 10, so we knew there was demand [for a separate interventional journal]," agreed JACC: Cardiovascular Interventions editor Dr Spencer B King III (Heart and Vascular Institute of St Joseph's Hospital, Atlanta, GA) when speaking to heart wire . "But as it has turned out, 80% of our submissions come directly to the journal."

[Source American College of Cardiology. Used with permission]

As of early 2008, King observed, his journal's acceptance rate was 17%. "We're trying to establish a journal with a high impact factor, with studies that will be cited," King said. "There are not any really high-impact-factor journals in the [interventional] field at the present time." Catheterization and Cardiovascular Interventions, the journal of the Society for Cardiac Angiography and Interventions (SCAI), runs a lot of narrowly focused technical reports, cases, and single-center experiences that would not be good candidates for JACC: Cardiovascular Interventions, according to King.

Regarding the impending launch of Circulation: Cardiovascular Interventions, King acknowledged there will be competition between the two publications, but "I think it will be good for interventional cardiology, frankly."

Dr Jagat Narula

Dr Jagat Narula (University of California, Irvine), editor of JACC: Cardiovascular Imaging, said both his publication and Circulation: Cardiovascular Imaging could help shape the role of imaging in cardiology. The different forms of cardiac imaging—predominantly echocardiography, computed tomography, magnetic resonance, and nuclear—have different strengths and limitations, he observed for heart wire . "The mindset should be one of integrating them in a way that achieves the best practice strategy." He wants his journal be "foremost a platform for promoting an ecumenical relationship between the distinct and often-competing imaging modalities."

Narula said, "Our role is to help create a new breed of cardiologist, the cardiovascular imager, who will be well versed with all the modalities and who knows which imaging modality is to be used in what patient." He thinks both of the new imaging journals will work in that direction. "Some competition is always bound to occur," he said, "but there is enough room for [both imaging journals] to exist. And my opinion, it reinforces the idea that cardiovascular imaging is maturing as a specialty."

Rationale for new publications: Other views

Roberts says the logic behind the societies' stated reasons for introducing the journals—that JACC and Circulation can publish only so many of the good papers they get, so they need new journals to put them in—assumes, incorrectly, that those journals don't already exist. "I think it was a money decision," Roberts said. "The AHA and ACC get a great deal of revenue from advertisers."

Dr Barry M Massie

"I think the view that there are more good papers to be published than can be published is just not accurate," Massie said. "There's no doubt that Circulation gets a huge number of submissions and has a very low acceptance rate, and certainly they do reject papers that deserve publication. But I would say virtually all of them do get published. I don't believe there are high-quality articles that aren't being published in existing journals, honestly."

Massie, whose journal is the house publication of the Heart Failure Society of America, said he was surprised that the AHA decided to start a heart-failure journal, "because there isn't a lot of advertising revenue there. We don't support our journal on advertising. . . . We're not publishing the journal to make money. Obviously, a journal like the New England Journal of Medicine must have enormous revenue from ads, and then it becomes as much business as an academic endeavor. I'm not sure where Circulation and JACC fall within that spectrum."

Massie continued, "I think Circulation really has good articles that they turn down, that they'd be proud to publish. That, of course, is why other journals, such as ours, recognize that some of the best articles that would have come to us probably won't come to us anymore."

The primary impetus for them was the interest and the need to be communicatinghigh-quality science as much as possible. The advertising component was, if at all, a secondary issue.

As to whether cardiac electrophysiology needs another journal, Prystowsky's answer is "unequivocally no. I don't think I would have said it 10 or 15 years ago before there was a JCE or Heart Rhythm around, but I know how many papers we reject—we reject the majority that come to us, and I know many times we're not getting them the first time around. There's probably a substantial number that come to us from JACC or Circulation. . . . Much of the stuff we reject is not the kind of stuff that would ever get into 'Circ EP.' "

Prystowsky said he knows why the AHA is releasing six new titles, and it doesn't have much to do with the official reason. "It's a question of need or greed." Someone at the AHA, he said, asked, "'How do we accept more papers. How do we get bigger?' Circulation already has the number-one impact factor in cardiology. Since [the Circulation EP journal] isn't needed, there's only one other reason to do it, which in my opinion is 'greed,' in quotes because it's not the money. They just want to publish more papers in the field than anyone else. What else could it be?"

[Source: American Heart Association. Used with permission]

According to Gutterman, "the primary impetus for them [the new Circulation journals] was the interest and the need to be communicating high-quality science as much as possible. The advertising component was, if at all, a secondary issue."

Moreover, he said, competition with JACC as motivation for the new publications has been overblown. "I don't think that was a reason for launching them, and to the extent that it influenced the decision, I would say that it was probably indirect."

Gutterman said he thinks the original idea for Circulation offspring developed "at least a year or two ago, when our task force on outcomes started meeting" and considered whether the AHA should publish a specific journal on cardiovascular outcomes and quality. "That was the one that got this started," he said. "There was a strong need, in epidemiology and outcomes, for a home for that kind of research that didn't really exist in cardiovascular disease. . . . I think that really, in part, spawned the idea for the other journals, as well."

Their new journals may be an attempt to say that they still represent all of cardiology, even if their meeting, which is still excellent, is shrinking.

The AHA, he said, sought the views of academic cardiologists, journal editors, and editorial boards as to what topics would be appropriate to cover with the new publications. It also hired consultants to survey general cardiologists in the US to find out what they wanted to see in journals. "The planned rollout is consistent with the results of that survey."

Massie granted that at least some of the new journals "make sense," especially Circulation: Cardiovascular Outcomes and Quality. "That is an underserved area," he agreed, "so it's an outstanding idea." It will probably have no shortage of submissions from researchers in the field who want to reach a cardiology audience, Massie said, "Although some of those articles will go to the New England Journal [of Medicine] and JAMA first."

He observed that attendance at the big annual meetings of the ACC and especially the AHA "has not grown as they expected and to some extent has fallen off." Some of the AHA scientific sessions attendance, for example, has been siphoned off by the annual TCT meeting, which is usually one or two months earlier. "So their new journals may be an attempt to say that they still represent all of cardiology even if their meeting, which is still excellent, is shrinking. I think launching these journals is their way of showing they still have a strong identity and still are leaders in the field."


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