Publishing in a heart failure journal-where lies the scientific interest?

When you create a new journal, like ESC Heart Failure, people give you a rather lot of time for development of style and performance. Nowadays, it regularly takes 4–6 years to get recognized in PubMed and then another 1–2 years to obtain an impact factor. That is, when all is going reasonably well.

When you take over an established journal, like the European Journal of Heart Failure, people expect fast success or at least visible change. With regard to the look and feel of a journal, editorial style, and communication as well as editorial office performance, it is indeed possible for a new editor‐in‐chief to give a journal a new style fairly quickly. However, performance markers like the impact factor can only be impacted upon slowly.

Marco Metra has been the editor‐in‐chief of the European Journal of Heart Failure since the end of 2014 with responsibility for all published articles since January 2015. Only slowly can we fully appreciate the impact he has on the flagship journal of the Heart Failure Association of the European Society of Cardiology. And only the 2017 impact factor, which will come out in the summer of 2018, will then fully reflect his work and that of his team.

During the last summer, we learned about the 2016 impact factors. The European Journal of Heart Failure strongly recovered from a reduction in impact factor last year and now features an impact factor of 6.968, which is markedly higher than its 2015 impact factor of 5.135, or the 2014 and 2013 impact factors of 6.526 and 6.577, respectively. For external comparison, the 2016 impact factors of JACC‐HF, Circulation Heart Failure, and Journal of Cardiac Failure are 8.493, 6.372, and 4.983, respectively.

The 2016 impact factor of a journal of interest is based on the 2016 citations anywhere in the International Scientific Indexing recognized journals of papers published in 2014 and 2015 in that journal of interest divided by the number of full papers and reviews published in that journal that year. Journals can, to a small degree, modify the number of papers published. However, fewer papers published means in the future also fewer papers to cite, so the impact of publishing fewer papers is at best short term. Whether we like this or not, the impact factor is key for the external reputation of a journal, and the number of citations to its articles is also key. In order to fully understand what kind of research is cited, reading rakings of best‐cited articles can be helpful. In Tables 1, 2, and 3, we list the 30 best‐cited articles of the European Journal of Heart Failure related to their respective year of publication; that is, 2014, 2015, and 2016. Of course, there is a time lag between publication and citation, and hence, it is not surprising that, on average, the articles of 2014 are somewhat more cited than those from 2015 or 2016. The 30th best‐cited article from 2014 was cited 24 times (Table 1), that of 2015 was cited 20 times (Table 2), and that of 2016 was cited only 11 times (Table 3).

Table 1

Top 30 cited articles, published in the European Journal of Heart Failure in 2014

Rank	First author	Title	Times cited
1	van Deursen	Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey1	69
2	Pieske	Rationale and design of the SOluble guanylate Cyclase stimulatoR in heArT failurE Studies (SOCRATES)2	52
3	Rogers	Analysing recurrent hospitalizations in heart failure: a review of statistical methodology, with application to CHARM‐Preserved3	49
4	Gronda	Chronic baroreflex activation effects on sympathetic nerve traffic, baroreflex function, and cardiac haemodynamics in heart failure: a proof‐of‐concept study4	47
5	McMurray	Baseline characteristics and treatment of patients in Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM‐HF)5	47
6	Lund	Association between cardiovascular vs. non‐cardiovascular co‐morbidities and outcomes in heart failure with preserved ejection fraction6	46
7	Huang	Uric acid and risk of heart failure: a systematic review and meta‐analysis7	43
8	Santos	Impaired left atrial function in heart failure with preserved ejection fraction8	39
9	Saberniak	Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members9	38
10	Tarone	Targeting myocardial remodelling to develop novel therapies for heart failure: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology10	37
11	Mentz	Decongestion in acute heart failure11	36
12	Mentz	International differences in clinical characteristics, management, and outcomes in acute heart failure patients: better short‐term outcomes in patients enrolled in Eastern Europe and Russia in the PROTECT trial12	35
13	Jhund	Independence of the blood pressure lowering effect and efficacy of the angiotensin receptor neprilysin inhibitor, LCZ696, in patients with heart failure with preserved ejection fraction: an analysis of the PARAMOUNT trial13	32
14	Brannstrom	Effects of person‐centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study14	31
15	Lam	The middle child in heart failure: heart failure with mid‐range ejection fraction (40–50%)15	31
16	Sliwa	EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM16	31
17	Pfister	Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC‐Norfolk study17	29
18	Clark	Worsening renal function during renin–angiotensin–aldosterone system inhibitor initiation and long‐term outcomes in patients with left ventricular systolic dysfunction18	29
19	Voors	Diuretic response in patients with acute decompensated heart failure: characteristics and clinical outcome—an analysis from RELAX‐AHF19	28
20	Duncker	Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function—value of the wearable cardioverter/defibrillator20	28
21	Russo	Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community‐based cohort21	28
22	Fito	Effect of the Mediterranean diet on heart failure biomarkers: a randomized sample from the PREDIMED trial22	28
23	Nymo	Inflammatory cytokines in chronic heart failure: interleukin‐8 is associated with adverse outcome. Results from CORONA23	27
24	Kang	Two‐dimensional speckle tracking echocardiography combined with high‐sensitive cardiac troponin T in early detection and prediction of cardiotoxicity during epirubicine‐based chemotherapy24	26
25	Sondergaard	Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure25	25
26	Cohen‐Solal	High prevalence of iron deficiency in patients with acute decompensated heart failure26	24
27	Boehm	Relationship between heart rate and mortality and morbidity in the irbesartan patients with heart failure and preserved systolic function trial (I‐Preserve)27	24
28	De Ferrari	Rationale and study design of the NEuroCardiac TherApy foR Heart Failure Study: NECTAR‐HF28	24
29	Merlo	Long‐term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years29	24
30	Valente	The Chronic Kidney Disease Epidemiology Collaboration equation outperforms the Modification of Diet in Renal Disease equation for estimating glomerular filtration rate in chronic systolic heart failure30	24

All data are as of 20 September 2017.

Table 2

Top 30 cited articles, published in the European Journal of Heart Failure in 2015

Rank	First author	Title	Times cited
1	Mebazaa	Recommendations on pre‐hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine31	85
2	Watson	MicroRNA signatures differentiate preserved from reduced ejection fraction heart failure32	45
3	Wong	Circulating microRNAs in heart failure with reduced and preserved left ventricular ejection fraction33	42
4	Pitt	Rationale and design of MinerAlocorticoid Receptor antagonist Tolerability Study‐Heart Failure (ARTS‐HF): a randomized study of finerenone vs. eplerenone in patients who have worsening chronic heart failure with diabetes and/or chronic kidney disease34	41
5	Ferrari	Heart failure with preserved ejection fraction: uncertainties and dilemmas35	40
6	Harjola	Clinical picture and risk prediction of short‐term mortality in cardiogenic shock36	36
7	Voors	Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction37	36
8	McMurray	Neprilysin inhibition to treat heart failure: a tale of science, serendipity, and second chances38	35
9	de Boer	State of the art: newer biomarkers in heart failure39	33
10	Edelmann	Galectin‐3 in patients with heart failure with preserved ejection fraction: results from the Aldo‐DHF trial40	33
11	Shimokawa	Heart failure as a general pandemic in Asia41	31
12	Bowen	Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle42	31
13	Rossignol	Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI‐HF and Val‐HeFT trials43	30
14	Kao	Characterization of subgroups of heart failure patients with preserved ejection fraction with possible implications for prognosis and treatment response44	29
15	Brunner‐La Rocca	Impact of worsening renal function related to medication in heart failure45	27
16	Lip	Heart failure in patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Pilot survey on Atrial Fibrillation46	26
17	Felker	Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX‐AHF study47	25
18	Coiro	Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure48	25
19	Akpek	Protective effects of spironolactone against anthracycline‐induced cardiomyopathy49	25
20	Sulaiman	Clinical characteristics, management, and outcomes of acute heart failure patients: observations from the Gulf acute heart failure registry (Gulf CARE)50	23
21	D'Elia	Role of biomarkers in cardiac structure phenotyping in heart failure with preserved ejection fraction: critical appraisal and practical use51	22
22	Steinbeck	Detection of muscle wasting in patients with chronic heart failure using C‐terminal agrin fragment: results from the Studies Investigating Co‐morbidities Aggravating Heart Failure (SICA‐HF)52	22
23	Anker	Maintenance of serum potassium with sodium zirconium cyclosilicate (ZS‐9) in heart failure patients: results from a phase 3 randomized, double‐blind, placebo‐controlled trial53	22
24	Pitt	Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalaemia in patients with heart failure and chronic kidney disease on RAAS inhibitors54	22
25	Larsson	Alcohol consumption and risk of heart failure: a dose–response meta‐analysis of prospective studies55	22
26	Heymans	Searching for new mechanisms of myocardial fibrosis with diagnostic and/or therapeutic potential56	21
27	Piepoli	ExtraHF survey: the first European survey on implementation of exercise training in heart failure patients57	21
28	Xiong	Non‐vitamin K antagonist oral anticoagulants (NOACs) in patients with concomitant atrial fibrillation and heart failure: a systemic review and meta‐analysis of randomized trials58	20
29	Gabet	National trends in rate of patients hospitalized for heart failure and heart failure mortality in France, 2000–201259	20
30	McDonagh	Iron therapy for the treatment of iron deficiency in chronic heart failure: intravenous or oral?60	20

All data are as of 20 September 2017.

Table 3

Top 30 cited articles, published in the European Journal of Heart Failure in 2016

Rank	First author	Title	Times cited
1	Ponikowski	2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC61	318
2	Lyon	Current state of knowledge on Takotsubo syndrome: a position statement from the task force on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology62	81
3	van Riet	Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review63	32
4	Vegter	MicroRNAs in heart failure: from biomarker to target for therapy64	29
5	ter Maaten	Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation65	28
6	Crespo‐Leiro	European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions66	27
7	Ovchinnikova	Signature of circulating microRNAs in patients with acute heart failure67	27
8	Triposkiadis	Reframing the association and significance of co‐morbidities in heart failure68	24
9	Jankowska	Effects of intravenous iron therapy in iron‐deficient patients with systolic heart failure: a meta‐analysis of randomized controlled trials69	23
10	Aschauer	The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics70	23
11	Vidan	Prevalence and prognostic impact of frailty and its components in non‐dependent elderly patients with heart failure71	22
12	Harjola	Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology72	21
13	Senni	Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double‐blind, randomized comparison of two uptitration regimens73	20
14	Stiermaier	Long‐term excess mortality in Takotsubo cardiomyopathy: predictors, causes and clinical consequences74	19
15	Demissei	Optimizing clinical use of biomarkers in high‐risk acute heart failure patients75	18
16	Christ	Heart failure epidemiology 2000–2013: insights from the German Federal Health Monitoring System76	17
17	Unger	Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction77	17
18	Anker	Traditional and new composite endpoints in heart failure clinical trials: facilitating comprehensive efficacy assessments and improving trial efficiency78	16
19	Schmidt	Thirty‐year trends in heart failure hospitalization and mortality rates and the prognostic impact of co‐morbidity: a Danish nationwide cohort study79	15
20	Mann	One‐year follow‐up results from AUGMENT‐HF: a multicentre randomized controlled clinical trial of the efficacy of left ventricular augmentation with Algisyl in the treatment of heart failure80	15
21	Bartunek	Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART‐1) trial design81	15
22	Vardeny	Efficacy of sacubitril/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM‐HF trial82	14
23	Pearse	Sleep‐disordered breathing in heart failure83	14
24	Komajda	Physicians' adherence to guideline‐recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey84	12
25	Maggioni	The real‐world evidence of heart failure: findings from 41 413 patients of the ARNO database85	12
26	Damman	Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction86	12
27	Klersy	Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta‐analysis of randomized controlled trials in patients with heart failure87	12
28	Chan	Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction88	12
29	Marques	The transcardiac gradient of cardio‐microRNAs in the failing heart89	11
30	Stugiewicz	The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications90	11

All data are as of 20 September 2017.

Nevertheless, this is not the whole truth. Certain very topical reviews and, in particular, guidelines get cited way out of proportion. The best‐cited and second‐best‐cited articles from 2014 have so far been cited 69 and 52 times, respectively (Table 1), and those of 2015 have so far been cited 85 and 45 times, respectively (Table 2). In contrast, the best‐cited and second‐best‐cited articles published in the European Journal of Heart Failure in 2016 were cited 318 and 81 times, respectively (Table 3). Not surprisingly, these articles are the 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure61 and the position statement from the task force on Takotsubo syndrome of the Heart Failure Association.62 Such articles provide guidance to a broad clinical community but often also form the basis of statements associated with many citations in the medical literature worldwide. To strengthen this point further, in Table 4, we list the 50 best‐cited papers published in the European Journal of Heart Failure. The number of citations varies between 1131 (rank 1, 2008 ESC Heart Failure guideline91), 719 (rank 2, 2012 ESC Heart Failure guideline92), and 505 for the classical heart failure is more ‘malignant’ than cancer paper of Simon Stewart and colleagues (rank 393) to a paper on serum levels of microRNA in heart failure patients published by Goren et al.139 and cited 127 times so far (rank 50, see Table 4). In the top 10 best‐cited papers published in the European Journal of Heart Failure, three are guidelines and four are big reviews. The next 10 best‐cited papers contain no guidelines, but others are five reviews, one meta‐analysis, and one trial design paper (Table 4). If one does not consider biomarker papers on circulating levels of cardiac autoantibodies129 or of microRNA139 basic science—which we don't—then we need to conclude that not a single article of the top 50 cited papers in the European Journal of Heart Failure deals with basic science research. This may be considered a weakness of the journal, or simply a reality. The basic science community does not submit its best papers to this journal, which is considered to mostly serve a clinical readership.

Table 4

Top 50 cited articles, ever published in the European Journal of Heart Failure

Rank	First author	Title	Times cited
1	Dickstein	ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008 The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)91	1132
2	McMurray	ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC92	719
3	Stewart	More ‘malignant’ than cancer? Five‐year survival following a first admission for heart failure93	505
4	Maisel	State of the art: using natriuretic peptide levels in clinical practice94	368
5	Ponikowski	2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC61	318
6	Oldenburg	Sleep‐disordered breathing in patients with symptomatic heart failure—a contemporary study of prevalence in and characteristics of 700 patients95	298
7	Stewart	The current cost of heart failure to the National Health Service in the UK96	297
8	Hall	Essential biochemistry and physiology of (NT‐pro)BNP97	249
9	Sliwa	Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy98	238
10	Vogels	Cognitive impairment in heart failure: a systematic review of the literature99	230
11	Cleland	The CARE‐HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end‐points100	208
12	Berry	Economics of chronic heart failure101	205
13	Lam	Epidemiology and clinical course of heart failure with preserved ejection fraction102	201
14	Gheorghiade	Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine103	199
15	Metra	Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance104	199
16	Cleland	Clinical trials update from the American Heart Association: REPAIR‐AMI, ASTAMI, JELIS, MEGA, REVIVE‐II, SURVIVE, and PROACTIVE105	197
17	Ingelsson	The validity of a diagnosis of heart failure in a hospital discharge register106	194
18	Hasselblad	Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE Trial107	193
19	de Boer	Galectin‐3: a novel mediator of heart failure development and progression108	185
20	Roccaforte	Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta‐analysis109	181
21	Damman	Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction110	179
22	Cohn	Adverse mortality effect of central sympathetic inhibition with sustained‐release moxonidine in patients with heart failure (MOXCON)111	179
23	Gras	Cardiac resynchronization therapy in advanced heart failure the multicenter InSync clinical study112	178
24	Jaarsma	Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology113	177
25	Piepoli	Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation114	174
26	Heymans	Inflammation as a therapeutic target in heart failure? A scientific statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology115	174
27	Hawkins	Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology116	169
28	Thackray	The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure—a meta‐regression analysis117	167
29	van der Wal	Non‐compliance in patients with heart failure; how can we manage it?118	162
30	Tavazzi	Rationale and design of the GISSI heart failure trial: a large trial to assess the effects of n‐3 polyunsaturated fatty acids and rosuvastatin in symptomatic congestive heart failure119	162
31	Zannad	Clinical profile, contemporary management and one‐year mortality in patients with severe acute heart failure syndromes: the EFICA study120	161
32	Shah	Galectin‐3, cardiac structure and function, and long‐term mortality in patients with acutely decompensated heart failure121	160
33	Maggioni	EURObservational Research Programme: the Heart Failure Pilot Survey (ESC‐HF Pilot)122	158
34	Franzen	MitraClip (R) therapy in patients with end‐stage systolic heart failure123	154
35	Eschenhagen	Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology124	154
36	Cleland	Clinical trials update and cumulative meta‐analyses from the American College of cardiology: WATCH, SCD‐HeFT, DINAMIT, CASINO, INSPIRE, STRATUS‐US, RIO‐LIPIDS and cardiac resynchronisation therapy in heart failure125	148
37	Metra	Advanced chronic heart failure: a position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology126	146
38	Remme	Comprehensive guidelines for the diagnosis and treatment of chronic heart failure—task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology127	143
39	Schwartz	Long term vagal stimulation in patients with advanced heart failure: first experience in man128	141
40	Caforio	Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance129	138
41	Rutten	Heart failure and chronic obstructive pulmonary disease: an ignored combination?130	136
42	Cleland	Is the prognosis of heart failure improving?131	136
43	Louis	A systematic review of telemonitoring for the management of heart failure132	135
44	Inglis	Which components of heart failure programmes are effective? A systematic review and meta‐analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane Review133	133
45	Jaarsma	Development and testing of the European Heart Failure Self‐Care Behaviour Scale134	133
46	Maggioni	Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long‐Term Registry135	132
47	Alonso‐Martinez	C‐reactive protein as a predictor of improvement and readmission in heart failure136	131
48	Cotter	Fluid overload in acute heart failure—re‐distribution and other mechanisms beyond fluid accumulation137	129
49	Maggioni	EURObservational Research Programme: regional differences and 1‐year follow‐up results of the Heart Failure Pilot Survey (ESC‐HF Pilot)138	127
50	Goren	Serum levels of microRNAs in patients with heart failure139	127

All data are as of 20 September 2017.

We believe that the results of this short analysis are not surprising. They can make the working of the impact factor and the realities of publishing articles better understandable or even predictable. We believe that the European Journal of Heart Failure under the stewardship of Marco Metra is thriving, and we are most optimistic that the journal will grow further in the next few years in quality, readership, and reach, and likely also in impact factor.