Social media and citations: what do cardiologists need to know?

Social media outlets are internet-based communication tools that allow individuals to interact by sharing and receiving information. Some common platforms are Twitter, Facebook, Instagram, YouTube, WhatsApp, and LinkedIn. The use of such platforms varies geographically (https://jacobsmedia.com/social-media-globally/) and by demographic group (https://www.pewinternet.org/2018/03/01/social-media-use-in-2018/). Additionally, some platforms are endemic to certain regions. For example, WeChat in China and Sonico in Latin America. For cardiologists, the most popular platform is Twitter.1 Many have celebrated Twitter as the new ‘hub’ for scientific discussion, generating ideas, forging collaborations, and rapid dissemination of results.2 Authors in Cardiovascular Research benefit from several social media platforms to increase the visibility of their article. Notable recent successes have come from two excellent but very different pilot clinical studies. Carnevale et al. detected subtle white-matter alterations in patients with hypertension3 and another by Elnabawi et al., which reported biologic therapy in psoriasis was associated with favourable modulation of coronary plaques.4 Ground-breaking pre-clinical work utilizing optogenetics as a new treatment avenue in atrial fibrillation,5 and another study that explored the sex differences in the role of perturbed circadian rhythm in cardiovascular disease6 also attracted significant Twitter buzz. Social media transcends the traditional clinician–patient relationship; this presents new and unique opportunities for patient empowerment7 and professional development for the cardiologist8 but also comes with pitfalls.9 The most common threats are: Lack of quality control of content Fear of missing out syndrome Harassment and public exposure Breach of patient confidentiality To minimize the risk of such threats, some general tips to follow are: Follow content from respected organizations and major cardiovascular journals Do not argue or write inappropriate comments in social media Always anonymize clinical images and videos and obtain written consent from patients to share their data. In 1991, an article in the New England Journal of Medicine showed that mainstream media coverage of a scientific paper was correlated with increased citations.10 Thus, in the present day, it is pertinent to ask if there is a relationship between social media buzz and citations? This is not at all an easy hypothesis to test. Notably, the biggest confounding factor is if social media activity (i) increases citations directly or (ii) if it is a reflection of the underlying quality of the article, which would have achieved high citations regardless. With regards a positive correlation between Twitter and citations, a recent study in 1599 primary research articles from 20 ecology journals showed that Twitter activity was a more important predictor of citation rates than 5-year journal impact factor.11 A study carried out by the Journal of Medical Internet Research showed that the number of tweets for an article was found to predict high citations within the first 3 days of article publication with 93% specificity and 75% sensitivity.12 One notable finding in this study was that interest on Twitter quickly decayed after the first 2 days of the article’s release. Therefore, the early Twitter bird certainly catches the worm! It also appears to matter who tweets about the paper, one study showed that papers that were shared on the Twitter accounts of Editors and Editorial Board members received more page visits than those papers tweeted only by the Journal account.13 On the other hand, a randomized controlled study in Circulation showed no difference in median 30 day page views when articles were exposed on social media platforms.14 In a follow-up study, a more intensive social media intervention by way of increasing the number of individuals who followed the social media accounts showed the same result.15 In addition to these studies are a number of others that have reported no clear relationship between social media activity and citations.16–18 In summary, Twitter is a tool that can be used to increase visibility of your manuscript. There is mixed evidence on whether this directly results in increased citations. Note that the uptake of Twitter is still low, only 10–20% of articles on PubMed are tweeted at least once.17 In a recent survey, almost half of users who tweeted an academic article were not associated with academia, thus they are unlikely to cite.19 The ESC Young Community has played a very active role in creating and delivering ESC social media content, with several examples of success that are providing high-quality cardiovascular science to people all around the world. Example of this are weekly ESC activities such as the “Clinical Case Challenge”, “ECG Challenge” and “Know your guidelines”. These are highly engaging and promote the online discussion of cardiovascular topics, boosting the learning experience. On Twitter, you can find these relevant handles: @escardio, the main channel of communication for the ESC on Twitter @ESC_news, official channel from ESC Media Office @ESC_journals, delivering recently published science from the ESC Journals family @CVR_TomaszGuzik, Cardiovascular Research editorial office Concerning the @ESC_journals handle, all articles featured have at least 24 h free access. As discussed above, social media promotion of a specific paper may boost its immediate visibility; however, does it increase its scientific impact and citability in the mid- to long-term? The ESC Journals team is now addressing this question in an ongoing study that randomizes papers for social media promotion. The primary endpoint will be the number of citations two years after the date of online publishing (Figure 1). Inclusion of the entire ESC Journal family will negate the limitation that has been present in other studies that have looked at a single Journal. Study design of a randomized trial carried out by the @ESC_Journals team. Study design of a randomized trial carried out by the @ESC_Journals team. I use it to learn from what many people are posting day by day. I like how the Twitter algorithm push contents according to your preferences about topics and people to follow. And—yes—it’s fun sometimes to share my opinion, too. Davide Capodanno Professor of Cardiology, University of Catania, Italy @DFCapodanno Twitter is the most powerful and fastest medical communication tool. We can interact with experts, share knowledge, and discuss in real-time current health trends and the news from major conferences. It helps people who share similar scientific interests to become good friends. Thais Pinheiro-Lima Assistant in Cardiovascular MR and CT, Sírio-Libanês and Nove de Julho Hospital, São Paulo, Brazil @thaples I use Twitter to stay updated, is the fast and more reliable way in the 21st century, without any doubt. If you are not on Twitter, you are one step behind. For me it’s essential to communicate the findings of Cardiology congresses and discuss since the first second all the trials. Rafael Vidal-Perez Cardiologist, Heart Failure Unit, Hospital Clinico Universitario de Santiago, Spain @rafavidalperez To keep up-to-date on grant and funding deadlines, new papers and conference talks I cannot attend. Also to disseminate educational info to the young Cardiovascular research scientist community. Jyoti Patel Research Fellow, Oxford University, United Kingdom @DrJyoti_Patel I use Twitter because it is an opportunity to ask, an opportunity to learn new things, an opportunity to share, and get answers to question. Scientifically, it helps more than other social networks, with less spam and more active communication. Amina Rakisheva Cardiologist, Scientific Institute of Cardiology, Almaty, Kazakhstan @ARakisheva To get the latest information before official paperworks are published regarding the latest research, journals, and clinical guidelines. To give comments related to colleagues’ techniques and report new techniques that I do as an interventionalist and get comments from them. Isman Firdaus Cardiologist, National Cardiovascular Center Harapan Kita, Indonesia @ismanf Conflict of interest: none declared. Biography: Dr Ricardo Ladeiras-Lopes is a Cardiologist dedicated to Cardiovascular Imaging (cardiac CT and CMR) at Gaia Hospital Centre and Physiology Assistant at the Faculty of Medicine of the University of Porto, in Portugal. Dr Ladeiras-Lopes has been involved in basic, translational, and clinical research activity since 2006 and his main areas of interest are diastolic physiology and pathophysiology and the application of cardiovascular imaging for unravelling the complex interplay between heart failure with preserved ejection fraction, obesity, metabolic syndrome, and inflammation. He has authored more than 20 papers published in peer-reviewed journals with more than 310 citations. Since 2017 Dr Ladeiras-Lopes is a Member of the Cardiologists of Tomorrow Nucleus of the European Society of Cardiology. In addition, he is a Member of the 2018–2020 Media Committee and Advisory Member of the 2018–2020 Digital Health Committee of the European Society of Cardiology. Ricardo Ladeiras-Lopes has a special interest in the utilization of Social Media as a tool for communication of medical and scientific content. He was appointed Twitter Editor of the European Society of Cardiology Journals. Biography: Dr Heather Y. Small is Senior Managing Editor of Cardiovascular Research. She is based in the Journal’s Editorial Office within the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, UK.