The European Heart Journal and the European Journal of Heart Failure : Partners in Scientific Publishing

More than 200 years ago, the English physician William Withering (1741–1799; Figure 1) learned of the remarkable successes of an old woman practising as a folk herbalist in Shropshire with a formulation of dried leaves in patients with, what we would call today, congestive heart failure. He started to use the remedy in his own practice and confirmed the effectiveness of the plant mixture in his own patients. In 1785, he published his seminal monograph ‘An Account of the Foxglove and Some of its Medical Uses with Practical Remarks on Dropsy and Other Disease’1 in which he identified digitalis lanata as the active ingredient. Although William Harvey had discovered the circulation and the role of the heart as a pump in his groundbreaking book ‘De Motu Cordis’2 more than a hundred years earlier, Withering did not fully understand the underlying causes of what he called dropsy. Nevertheless, his oedematous and dyspnoeic patients started to urinate, lost weight, and felt better in response to his novel remedy. To most physicians, heart failure really became known as a clinical entity in the 20th century and gradually became a manageable condition in the last decades. With the introduction of diuretics after the Second World War, another effective tool besides digitalis became available, but only in the late 1970s, with the advent of large clinical trials, were drugs introduced into clinical practice that for the first time were able to prolong life in patients with heart failure. Indeed, in 1973, Finn Waagstein showed that—contrary to the expectation of most physicians—beta-blockers appeared to exert beneficial effects in patients with pump failure. 3–5 Shortly thereafter, Jay Cohn showed that unloading, rather than stimulating the heart with vasodilators, improved outcome. 6 He further demonstrated that the degree of activation of the renin–angiotensin system, as well as the sympathetic nervous system, was predictive of outcome. 7 Thanks to a seminal observation of the later Nobel Laureate Sir John Vane that the toxic effects of the venom from the Brazilian viper (Bothrops jararaca) are due to a sudden, massive drop in blood pressure, a novel class of agents was discovered at the Squibb Laboratories in New Jersey with the help of Miguel Ondetti and David Cushman: the angiotensin-converting enzyme (ACE) inhibitors. 8 This led to a series of trials establishing ACE inhibitors and beta-blockers as standard treatment of chronic systolic heart failure. Of note, 25 years ago, Karl Swedberg and colleagues published the CONSENSUS trial, 9 clearly a landmark study which made ACE inhibitors a standard remedy in heart failure. 10 A few years later, trials with beta-blockers such as metoprolol (MERIT), 11 bisoprolol (CIBIS), 12 and carvedilol (COPERNICUS) 13 followed. With the publication of RALES by Bertram Pitt et al. using the mineralocorticoid receptor antagonist spironolactone in 1999, 14 the current standard treatment of chronic heart failure was established. In response to the increasing interest in heart failure and the increasingly evidence-based management of this condition, the European Society of Cardiology (ESC) in 1999 established a subspecialty journal on this subject, initially as a quarterly publication, the European Journal of Heart Failure under the leadership of its first editor-in-chief John Cleland from Hull assisted by Gillie Porter (Figure 2). In 2005, Karl Swedberg from Göteborg became responsible for the European Journal of Heart Failure and expanded its scope by publishing monthly issues. The current editorial team led by Dirk van Veldhuisen in Groningen took over in 2010. Ever since, the ESC has published guidelines on the management of heart failure15 both in the European Heart Journal and simultaneously in the European Journal of Heart Failure to allow for the translation of research findings into clinical practice. More recently, with the introduction of biventricular pacers in the management of heart failure, 16 the guidelines had to be updated. 17 Today, heart failure can be managed in an evidence-based fashion by a combined approach using lifestyle measures, effective drugs, biventricular pacers with or without an implantable defibrillator, and, in severe forms, using left ventricular assist devices and heart transplantation. This progress notwithstanding, heart failure remains a condition with a fierce prognosis. Furthermore, the number of patients with this condition is steadily growing (Figure 3). Indeed, heart failure accounts for 280 000 deaths, 1. 1 million hospital admissions, and a total healthcare expenditure of US33. 2 billion each year in the USA, with similar numbers reported in Europe. 18 The growing number of patients has been ascribed to (i) the ageing Western societies; (ii) the increasing number of survivors of myocardial infarction with left ventricular dysfunction; and (iii) the prolonged survival of hypertensives and diabetics due to modern, but less than perfect treatment strategies. Due to its high prevalence and unfavourable prognosis, heart failure remains a subject of great interest and intensive investigation. Indeed, the European Heart Journal receives a large number of manuscripts on this subject every year. 19 Together with the submissions to other leading journals, heart failure has become a subject of intensive scientific interest. As expected, guidelines are the most cited articles in this area too. Indeed, the ‘ESC Guidelines on the management of chronic heart failure’ were published in 2008 simultaneously in the European Heart Journal15 and in the European Journal of Heart Failure, and since then have been cited 774 and 496 times and downloaded 29 425 and 12 116 times, respectively. Similarly, the ‘Focused update of the guidelines on device therapy in heart failure’17 received 44 citations and was downloaded 3130 times. Guidelines related to heart failure such as those on the ’Diagnosis and treatment of pulmonary hypertension‘20 (252 citations and some 28 600 downloads) and those on the ’Management of grown-up congenital heart disease‘21 (28 citations and 4402 downloads) also received appropriate attention. Over recent years, besides the guidelines, several original research papers on heart failure published in the European Heart Journal have been highly cited, for instance a review by Borlaug and Paulus on heart failure with preserved left ventricular function, 22 a particularly challenging field of cardiology. Novel devices have revolutionized the management of such patients as outlined in detail in a review by Singh and Gras. 23 Central haemodynamics, such as central systolic blood pressure and central augmentation index, have also emerged as important prognostic factors of outcome and mortality in subjects with normal left ventricular function or heart failure, an analysis published in the European Heart Journal that was also highly cited. 24 The interplay of the heart and the kidney appears particularly important in such patients as outlined by a highly cited report from the Consensus Conference of the Acute Dialysis Quality Initiative (ADQI). 25 Although the activation of the renin–angiotensin system and of the sympathetic nervous system has been well characterized in heart failure, the role of the vagus has been neglected. The highly cited open-label phase II study by De Ferrari et al. demonstrated for the first time that chronic vagus nerve stimulation is associated with improvements in New York Heart Association (NYHA) class, 6 min walk test, left ventricular ejection fraction, and systolic volumes up to 1 year, and sets the stage for further investigations and clinical trials in this new era of device therapy. 26 The prevention of heart failure after myocardial infarction by cell therapy has attracted particular attention in the European Heart Journal. Indeed, the discovery of progenitor and stem cells in our body potentially able to regenerate various tissues has raised great hopes also in cardiovascular medicine. 27 The REGENT trial by Tendera et al. 28 was cited >80 times, although it found that in acute coronary syndrome (ACS) with impaired left ventricular ejection fraction, treatment with bone marrow-derived CD34+CXCR4+ cells did not improve left ventricular pump function or volumes. The Dutch HEBE trial by Hirsch et al. 29 was just recently published and hence has received just a handful of citations, but confirmed the neutral results of REGENT in 200 ACS patients. Thus, the effectiveness of cell therapy in cardiac patients remains uncertain. The ESC started its first journal in 198030 under the leadership of Desmond Julian with a small number of submissions and no impact factor (IF). Over the last 30 years under the leadership of four successive editors (i. e. Henry Kulbertus, Kim Fox, Frans van de Werf, and Thomas F. Lüscher30), the European Heart Journal has made it to centre stage in cardiovascular medicine. 31 Indeed, the submissions have increased steadily over the years and reached >3700 per year recently. As a consequence, the acceptance rate has decreased to ∼10% and its IF rose to 10. 5 (Figure 4). However, it was not just the main journal that contributed to the success of the ESC, rather a growing number of subspecialty journals was part of this success as well. Indeed, the rapidly evolving fields of cardiology started to become true subspecialties requiring journals focusing on their specific area of interest. After the introduction of the first subspecialty journal, Europace, in 1999, the European Journal of Heart Failure followed in the same year, while in later years an increasing number of additional journalswas created (Figure 4). Today the ESC journal family encompasses nine journals covering the entire spectrum of the subspecialites of cardiovascular medicine. Importantly, EuroIntervention has recently reached an official agreement with the ESC, and thus this important subspecialty journal is added to the ESC journal family. Furthermore, the European Journal of Echocardiography expanded its scope as of this year under its new name, the European Heart Journal Cardiovascular Imaging. Finally, the European Journal of Cardiovascular Prevention and Rehabilitation changed its name to the European Journal of Preventive Cardiology. With the exception of Cardiovascular Research, which focuses on basic aspects of cardiovascular disease, the European Journal of Heart Failure is the most successful product, with a steadily increasing IF reaching 4. 895 in 2011 and a yearly submission rate of >800 manuscripts. With the new editorship of the European Heart Journal which started in 2009, the ESC journal family came closer together. Indeed, a manuscript transfer system has been established allowing for transfer of papers reviewed by experts of the main journal to a suitable subspecialty journal. With the decreasing acceptance rate down to an all-time low of 10%, the editors of the European Heart Journal are forced to reject an increasing number of interesting papers due to priority and space. Obviously, more than 10% of the submitted papers are worthy of being published. Some just did not make it due to space limitations, others are interesting only for cardiologists working in heart failure or other subspecialties, while some are too technical for the general reader. The transfer system now allows the rescue of such papers that are excellent, but better suited for subspecialty journals. The subspecialty editor receives the manuscript with the available reviews and can offer re-submission of a revision based on the available reviews, provided he considers the paper interesting and the reviewers’ comments constructive. The authors then receive a decision letter with such an offer and may or may not resubmit a revised version of their manuscript complying with the recommendations they have received (Figure 5). Since the introduction of the manuscript transfer system, we have transferred 948 papers to different subspecialty journals, 456 or 48% of them to the European Journal of Heart Failure. Overall, the offered manuscripts were accepted pending revision, as suggested by the initial reviews provided by the European Heart Journal (during the first round of reviewing), by the responsible subspecialty editors in 60% of cases. Of these offers, 55% were accepted by the authors and later resubmitted in revised fashion to the subspecialty journal. Eventually, 36% of transferred manuscripts were accepted and published. Of note, the acceptance by the authors depended to a large extent on the IF of the subspecialty journal that was offered for re-submission (Figure 5). Indeed, the author acceptance rate was the highest for the European Journal of Heart Failure (52%; IF 4. 512), lower with the European Journal of Cardiovascular Prevention and Rehabilitation (47%; IF 2. 633), and the lowest with Europace (27%; IF 1. 839) and the European Journal of Echocardiography (10%; IF 2. 117). As the European Heart Journal has not received manuscripts on cardiovascular nursing, no manuscripts were transferred to this subspecialty journal. It is the intention and hope of the publication committee of the ESC that with this strategy the manuscript flow to the entire ESC journal family will increase and, in turn, the quality of the manuscripts and the IF of all journals will rise. Indeed, since the introduction of the manuscript transfer system, the impact factor of the European Journal of Heart Failure has increased by 1. 189 (from 3. 706 to 4. 895). The manuscripts transferred to and eventually published by the European Journal of Heart Failure (Figure 4) in the period 2010–2011 were generally cited slightly more frequently than those submitted directly. As discussed above, the transfer system is attractive for the subspecialty journals, since it saves a lot of time for both reviewers and authors, and eventually provides high-quality papers. Clearly, the best cited papers in the European Journal of Heart Failure were the Guidelines, 32 but almost as well read and cited were Position Statements, such as those recently published on congestion, 33 peripartum cardiomyopathy, 34 cardiovascular side effects of cancer therapies, 35 and definition of cardiac hypertrophy. 36 Position Statements in general do not get transferred, but are usually sent directly to the European Journal of Heart Failure. This equally applies to Consensus Documents or Position Papers, that were recently published on exercise training37 and acute heart failure. 38 The European Journal of Heart Failure is focusing on all aspects of heart failure, but three fields are of particular interest: (i) experimental or animal research; (ii) studies in the field of arrhythmias and electrophysiology as well as devices (both therapeutic and diagnostic) ; and (iii) design papers of large heart failure trials. We believe that the first category is important, because basic research is essential to the journal, but also for the ESC Heart Failure Association as a whole. This is reflected by the great interest of the heart failure community shown in the Annual Winter Meeting in Switzerland, which focuses on Basic Science, and which has now also been included in the recent Clinical Trials Update paper by Cleland published in our journal. 39 Secondly, the field of arrhythmias and electrophysiology40, 41 devices (both intra- and extracardiac), 42−4344 and telemonitoring45, 46 is of importance because some of the big breakthroughs in recent years in the management of heart failure have been achieved in this particular field. Moreover, this field continues to develop, and the European Journal of Heart Failure wants to emphasize its interest in this area. As a third category, the European Journal of Heart Failure welcomes design papers of large heart failure trials, since we believe that such papers provide important information and secure the quality and integrity of large trials. 47484950−51 Indeed, the European Journal of Heart Failure has become a grown-up child in the ESC journal family. After a steady increase in the last 10 years, the impact factor for 2010 was 4. 5, and it further increased to 4. 9 in 2011 (Figure 6). For this reason, it is often attractive to authors who have initially submitted their manuscript to the European Heart Journalfor it transferred to the European Journal of Heart Failure. In summary, the ESC journal family is on the move and it is hoped that it will grow into the prime educational product in cardiovascular medicine as has the Annual Congress in its own field—L'Union fait la Force is our current strategy that hopefully will pay out as much in the future as it already has in recent years. Conflict of interest: none declared.