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Circulation on the Run

Jun 24, 2019

Dr Amit Khera:                  Welcome to Circulation On The Run. Our weekly podcast summary and backstage pass to the Journal. I'm Dr Amit Khera, associate editor and digital strategies editor from UT Southwestern Medical Center in Dallas, and I had the distinct privilege of standing in for Dr Carolyn Lam and Greg Hundley this week. Twice a year, we are very fortunate to have some unique podcasts when we don't have circulation issues, and in the past we've met with many fellows in training and heard about some interesting studies that they're doing. Today we have a very special podcast we have not done before, and that is one where we had the opportunity to learn about our Circulation Family of Journals, and more importantly to hear from the dynamic editors in chief of these various journals. I think you're really going to enjoy it, we'll walk through and hear from each one of them, hear about some of the innovative things that are happening, some of the future that they see for their journal in their field, and I really enjoyed it, and I'm sure you will as well. So, without further ado, we'll start with our first editor.

Dr Sunil Rao:                      I'm Sunil Rao. I'm an intervention cardiologist at Duke, and I'm the Editor-in-Chief for Circulation Cardiovascular Interventions, which is one of the daughter journals of the Circulation Family. We publish articles really related to the broad spectrum of interventional cardiology, from coronary interventions to peripheral arterial disease, and Endovascular interventions to structural heart disease interventions. We also published review articles in all of those areas, as well as any health policy or outcomes studies that are in that space.

Dr Amit Khera:                  Tell us what are some of the innovative things that your journal is doing this year.

Dr Sunil Rao:                      We're really excited about two things, one is our extremely successful Assistant Editor program that we launched last year at A.H.A. 2018. This is a program where we have five early career individuals that are within five years of completing their fellowship program who joined the editorial team at Circulation Cardiovascular interventions, and in that role they really learn a lot about the mechanics of how scientific publishing works, they commit to doing manuscript reviews, and receive feedback on improving their peer review process, and even independently handles some manuscripts as well, that are in their areas of interest. This is our way, I think, of encouraging the next generation to stay engaged with science, and with the scientific publishing process. It's been extremely successful. Assistant editors are part of our team for a two year term. So, in 2020, we will be selecting the next class of assistant editors, and after their term is ended, they join our editorial board as editorial board members. So, we're really excited about that, it's been an overall positive experience, for I think everybody involved. The second thing that we're really excited about is that we launched a social media presence for the journal, which it previously did not have. So, we have a very active Circulation Cardiovascular Interventions Twitter handle, I encourage all the listeners to join Twitter if you're not on Twitter, and if you are on Twitter please follow at Cirque intervened. It's " at C.I.R.C.I.N.T.V.". That is the official Twitter handle for our journal. Dave Fishman is our social media editor, and Chadi Alraies is our assistant social media editor, and we're not just tweeting out the articles, and providing summaries when the papers get published, we're holding Twitter journal clubs once a month ,and these have been extremely successful, it's an hour long Twitter journal club where the discussion gets very intense, and there's a lot of back and forth. We try to have the authors on as well, so that they can explain the rationale for their study, some of the challenges that they face when they are doing the study, and hopefully provide some implications for clinical practice, and what the next steps are. That's a way for us to engage our readership, it's almost a form of post publication peer review, which I think is becoming very popular. In addition, remember we don't have a print format of our journals, so this is a way to get the readership more engaged with the Web site, and to come to our website and learn what elsewhere publishing, and how they can get involve with the Journal as well, both as authors who submit their work, or if they want a peer review for us, please contact us and let us know.

Dr Amit Khera:                  I really love hearing about the Twitter journal club, I know that they are well received, and certainly getting a lot of traction. Tell us about what initiatives or topics you're most excited about this year, and maybe some things that are coming later in the year.

Dr Sunil Rao:                      We're really excited about the big areas in interventional cardiology, which are coronary physiology, we've published quite a few papers on looking at different physiological parameters, and how they can drive the appropriate use of PCI and how that affects outcomes. I think that's going to continue to be a huge topic over the next year, Certainly such a heart disease has exploded, and with the data on low risk patients undergoing TAVR, and having really good outcomes, we're seeing a lot more submissions in the low risk TAVR space, the other area that's really exploding right now is Mitral and Tricuspid Valve Interventions, one of the areas that I think has seen a tremendous amount of device innovation. So, we're seeing a lot of submissions from really high quality papers in that space, but I think it's also important to note, that unlike previous iterations of the Journal, we're actually having a review article, we're trying to have a review article every month on a major area that is burgeoning, so that the readership can understand the overall lay of the land, with respect to evidence, how that guy's clinical practice, and what's coming next. So, we've published quite a few review articles already, and there are more to come, and I think that's a really important way for the readership to keep current with what's going on in Interventional Cardiology.

Dr Amit Khera:                  What about the advancing aspects of your subspecialty? There's so much going on in interventional cardiology, it's a bit dizzying, just tell us a little bit about some of the ways that your journal's helping advance that mission, not just now but perhaps in the future.

Dr Sunil Rao:                      I think one of the challenges that we have at Interventional Cardiology, and maybe this is true across Cardiology, is that the evidence is developed very rapidly, and oftentimes it almost seems like the field is lurching back and forth in certain areas, a prime example of that is the drug coated balloon controversy for Peripheral Interventions. The Journal Of The American Heart Association published a meta-analysis, showing that there may be an association between the use of these devices and increased mortality, that has led to a lot of discussion in the interventional community, and quite frankly I think there's a fair amount of confusion out there about whether we should be using these devices, should we put a moratorium on these devices, is the signal real, if it is, what's the mechanism of death. So, a lot of conversation around that, in fact, it's led to what's going to be a focused FDA meeting in June, specifically on the drug coated balloon controversy. Where I see our journal playing a role is really in trying to, not only publish the latest science, which is rigorous in the field for controversial topics such as this, but also to help provide some context for that science, and I think our integrated strategy of original science review articles, and social media really helps us to communicate with the readership, and with the Interventional Cardiology community writ large, meaning not just physicians, but also Cath lab staff, nurses, noninvasive cardiologists who obviously have patients who are undergoing interventions, and even policymakers, to keep them abreast of what's going on, so that they can have the same level or base of knowledge, so that the conversation is on a level playing field.

Dr Amit Khera:                  Okay, well you heard it from Dr Sunil Rao. Thank you for your time.

Dr Kiran Musunuru:        I'm Kiran Musunuru, I'm the outgoing Editor-in-Chief of Circulation Genomic and Precision Medicine. Let me start by saying a little bit about the content of the journal, it considers all types of articles related to, as the name implies, Genomic and Precision Medicine, and more specifically, Clinical Genetics, the molecular basis of complex cardiovascular disorders, considered at a variety of levels, that can include a lot of different, what we would call Omics Techniques, from Genomics to Transcriptomics, Proteomics, Metabolomics, Metagenomics, and, so forth. It also deals with big data applications, that includes Electronic Health Record Data, Patient generated data combined with any of the things I've already mentioned, Genome Wide Association Studies, Pharmacogenomics, Gene Therapy, Therapeutic Gene Editing, Systems Biology. So, it's a pretty comprehensive look at all the various topics that would fall under the rubric of Genomic and Precision Medicine.

Dr Amit Khera:                  Now, Dr Musunuru, you mentioned the outgoing Editor-in-Chief, let's introduce the incoming Editor-in-Chief, Thatcher Christopherson Semsarian.

Dr Chris Semsarian:         I'm the incoming Editor-in-Chief. My name is Chris Semsarian, I'm a cardiologist at the Royal Prince Alfred Hospital in Sydney, Australia.

Dr Amit Khera:                  What are some of the innovations you and the Journal are doing this year, or, what are some of the things you see coming in the future?

Dr Kiran Musunuru:        Something I'm very excited about, is that we are just starting a pilot project with the American Heart Association's Institute for Precision Cardiovascular Medicine. The institute has a very nice platform called the Precision Medicine platform, and, in brainstorming last year, we realized there was a very nice opportunity to try to create a new type of journal article. There's also a big move in science nowadays to improve transparency, and rigor, and reproducibility, especially in science. The idea being that ideally other investigators should be able to take one team's work, and be able to run through the entire analytical process, and reproduce the original findings, and perhaps even find ways to improve upon those original findings, and, so we realized working with the institute's Precision Medicine Platform, we had the opportunity to actually make a new type of article, we think of, as the paper of tomorrow, a virtual article. The idea would be, that we would have primary data on the Precision Medicine Platform, the analytical tools used to process the data would also be on the Precision Medicine Platform, the analytical plan, in the form of a so-called Jupiter notebook, that basically takes people step by step through exactly which tools were used in which order, in which way, with which parameters, would be on the Precision Medicine Platform, and then there would be some verbal explanation, some background, to explain the context of these analysis, and to really put it into perspective, as how it fits into the body of literature, and so the idea would be, this would live on the Precision Map Platform in a virtual format, and then anyone else who is interested in this work could come, and actually directly interact with the data, and the tools, and the analytical plan, and could actually rerun the entire papers work from scratch, thus reproducing it, and then could actually tweak the analytical plan, or install tools of their own, and be able to build upon the work that had already been done. It's a very different way of thinking about journal articles, more as living entities rather than static work that just lives on a page, and is there as reported, and then never has an opportunity to be fully produced or improved upon.

Dr Amit Khera:                  There's so much happening in the space of genomics, and obviously, we hear the word "Precision Medicine" so commonly. Tell us a bit about how your journal in specific is advancing the mission of your area.

Dr Kiran Musunuru:        I'll say a little bit, and then maybe turn it over to Chris, give his perspective as the incoming Editor-in-Chief. I think it's a vibrant field, but it's also a very new field, it's evolving rapidly, and I think the Journal has a very important role to play, and not only reporting the results that are coming out of studies in this field, but actually having a role to play in helping to shape the field, helping to define the field, it's very exciting, it's very much in rapid evolution. Just ten years ago or so, when the Journal first started, we were just starting to see the first Genome Wide Association studies, and now we've gone so far beyond that.

                                                Now, again, we're talking about these large bio banks, we're talking about Precision Medicine, we're talking about applying this information in health care, we're talking about combining all of these various streams of data and many levels to be able to do studies, that are, I would even say, exponentially advanced beyond what we able to do just ten years ago, and so, it's very exciting times for the journal, then maybe I can ask Chris to share his thoughts on that.

Dr Chris Semsarian:         Yeah Kiran, I mean, it's a great honor system to follow in your amazing footsteps, and what you've done for the Journal, and as the incoming Editor-in-Chief, I really want to sort of try, and build on the platform that you've established over the last few years, and really, one of the areas that I'm particularly interested in is the area of Translation of Genomic Findings. I mean, ultimately what we do in our lives, as clinicians, is to help patients improve diagnosis, to improve the treatment of these patients, and to be able to do studies with very basic understanding of how our genomes work, and how Narcotic Genes interact, and translating those findings into these improved diagnostic approaches, and even in guiding management is really exciting, I think, in terms of clinical medicine, and improving patient care as we look ahead. I really want to be able to continue to publish really, state of the art, novel, innovative, research areas, that you've already covered, Kiran, which would lead to better care of our patients, who are ultimately the beneficiaries of this type of amazing work.

                                                So, I'm really excited looking at the Journal, it's a tremendous area of interest and research, where there's twenty-two thousand genes approximately now genomes, and we really don't understand most of them in terms of their intricate function, and I figured it's a great time ahead, in terms of Precision Medicine.

Dr Amit Khera:                  Okay, well, that was Dr Kiran Musunuru, and Christopher Semsarian, we appreciate both of your time today for Circulation on the Run.

Dr Paul Wang:                   I'm Dr Paul Wang, I'm the Editor-in-Chief of Circulation Arrhythmia and Electrophysiology. Our Journal covers really the expanse of our field, going from basic mechanisms of arrhythmias, so very basic science work, to really clinical practice, clinical outcomes, to population based studies, and genetic based considerations in our field. So, we really feel we encompass the entire range, and there really isn't any topic within our area, that we don't feel is outside our realm.

Dr Amit Khera:                  I know there's so many innovative things you're doing, Dr Wang, with your journal. Why don't you tell us a little bit about your plans for this year.

Dr Paul Wang:                   We've been excited; our team has been at the Journal for two years now, and we focused on a number of different areas. So, I think one of our biggest advances, and we've tried to be more responsive to the authors, so we've really reduced the time to first decision very substantially, from over twenty days, to ten days or less, I think we hit a record of 7.8 days in the journal. So, really, we hope we're more responsive, we've involved the editorial board, we've substantially expanded it, so that more of our reviews of greater proportion going to our editorial board, which is a really fabulous, internationally recognized group, with really high quality reviews, so we've been very pleased, with both a level of science that we've received, as well as the level of the reviews that we have. One other area is, we really want to make sure that the reviewers, who do much of the heavy lifting, in addition to our editors for The Journal, and so we've established a new Reviewer Recognition Award System, they can be designated as silver, gold or platinum, and we've reached out to department chairs, or their deans, and recognizing that they won this prestigious award for their performance, and great work with the Journal, so there are a number of different things that, in fact, we think we've made some advances in, the other areas are really that of extending our reach, and so, one of the things we concentrated on, initially with the adding of podcasts, so we do that monthly.

                                                All the articles are now available in review, and then what we're starting at our new initiatives is, we'll be starting a Twitter Journal Club. I've been recording at least two of our articles, as the interview with the authors, and then we're going to be having a journal club, in which we will have the opportunity for people around the world to comment, and have a discussion that will really be exciting, we think. So, there are a number of other areas that we're thinking about, in terms of that kind of work.

Dr Amit Khera:                  The field of Electrophysiology seems to be changing by the day, maybe you can tell us a little bit, about how the journal is advancing the mission of the field of electrophysiology.

Dr Paul Wang:                   So, one of the things that we focused on is the role the Journal can play, in terms of connecting with other elements of our field, and one of the ways that we've really concentrated on is, in particular, working closely with the American Heart Association, and its committees. We're related to a number of committees, but particularly, there is a committee on Electrocardiography, Electrophysiology, part of the Clinical Cardiology Council, and so, we work very closely with that group, and, in fact, we've invited that group to create proposals for a number of review articles, state-of-the-art reviews, that we hope will come out in the next year or so. The ways in which we can tie together our committees to AHA overall, I think, is really the direction we're looking for our journal, and we feel we can play a very novel, and innovative role in that regard. We, for example, also reached out to the American Heart Association funded researchers in our area, and invited them to participate in the journal, participate in our committees, become fellows or FAHA's of the American Heart Association, so we really want to create this family, a real community, and sense of community, that we hope will stem from the Journal. So, we're very excited about the future, and what we might be able to achieve together.

Dr Amit Khera:                  Thank you so much, Dr Paul Wang for your time today, and we appreciate your insights on Circulation, Arrhythmia and Electrophysiology.

Dr Nancy Sweitzer:          Hi, I'm Nancy Sweitzer. I'm the Editor-in-Chief of the Journal Circulation Heart Failure. At Circ Heart Failure, we deal with all things related to heart failure. Heart failure is an expanding specialty, relatively new subspecialty in cardiology, and we're very interested in the physiology, and mechanisms of heart failure, as well as treatments of heart failure, and the innovative evolution of the specialty which includes Advanced Hemodynamics, Mechanical Circulatory Support, and transplant as therapies, as well as all Implanted Device Therapies, and new, and Innovative Pharmacologic, and Gene Therapies as well.

Dr Amit Khera:                  Tell us a bit about initiatives, or features in Circulation Heart Failure, that you're planning on tackling not only this year, but into the future.

Dr Nancy Sweitzer:          The effort we're most excited about at Circulation Heart Failure has been ongoing now for a little over a year, but continues, and is really focused on the emerging scientists in the Heart Failure Space; we call it our "Featured Emerging Investigator Spotlight", and this spotlight focuses on authors of manuscripts, who are within ten years of their terminal training, and can take full responsibility for the content of a manuscript. When we publish a featured emerging investigator article, which we've done more than half of the months since launching the feature in late 2017, we schedule a Twitter Journal Club with that author, where we participate, over the course of several hours, in pretty intensive conversation, about not only the science, but career development in Heart Failure Space, the importance of mentoring, and sponsorship obstacles that people are facing in development as physician scientists or scientists, and insights they may have into fostering success in the Heart Failure Space. This has been a great feature, we launched it because we feel that the emerging scientists, in the Heart Failure Space, need a virtual community in those critical years, before you have a lot of resources to start traveling, and setting up a network that's based on personal interaction, and we felt that, the modern era of social media was perfect for this. We found our emerging investigators are getting to know one another, they participate in one another's Journal Clubs, the Journal Clubs are incredibly fun, and interactive and we're getting a lot of Twitter engagement from the Heart Failure Community, there's a lot of "Twitteratti" in Heart Failure that really are engaged, and engaged with the Journal, which has really been fun for all of us, I think, so that's the thing we're most excited about.

Dr Amit Khera:                  It's really wonderful to hear how you're spotlighting authors in creative ways. Tell us a bit about how your journal is advancing the mission of Heart Failure and Transplantation.

Dr Nancy Sweitzer:          I see the journal as central to advancement of the subspecialty, as I mentioned earlier, Heart Failure is a relatively young subspecialty in the United States, we received a CGMC designation as a subspecialty just in 2008, just eleven years ago, and it's been a board certifiable subspecialty only since 2014. So, we're very young, and I think really developing into our own. We've seen tremendous growth in the number of people seeking subspecialty training in Advanced Heart Failure and Transplant Cardiology, and we are really enjoying helping the Journal evolve with the specialty, as it evolves, and that's happening very actively right now. So, I think what Heart Failure is in 2019 is different than what it was just five years ago in 2014. We're doing a lot more ,as I mentioned, Complex Chemo Dynamic Thinking, thinking about the path of physiology in our patients, and how we can target that effectively, not only with existing therapies, but with strategies, and, as I mentioned, the burgeoning growth of Mechanical Circulatory Support, and support devices, which the field has embraced quite actively, and The Journal is increasingly publishing content in these spaces, as well as the spaces of Advanced Heart Failure, but, I guess also, we're interested in every aspect of Heart Failure, from Complex Multidisciplinary Care Management, to Palliative Care, to the interaction of the heart with other organ systems, and Heart Failure such as the brain, we have a paper on Cognitive Function Abnormalities, and Heart Failure in this month's issue. So, the interaction with the brain, the kidney, the liver, many other organs, that are affected when the heart becomes quite ill with Advanced Heart Disease. So, basically we're interested in everything that touches Heart Failure Development Care, and treatment of patients with Heart Failure, and particularly we're interested in the newest and latest. We love publishing, and some of our highest impact papers in the last couple years have been new therapies, just being tested for the first time in patients with heart failure. Small studies that may not have large impact in terms of heart outcomes, but where we're learning about the pathophysiology of the disease, and new treatments, that's really exciting to us. We've published a couple of methods papers in the last year, really innovative models. One describing a model of pacing in mice, which has been a really challenging thing to do in Heart Failure, but several groups have now developed Tachycardia induced Cardiomyopathy models in mice, which is important for rapid discovery work, because mice have such a short reproductive span, and can be genetically altered, and then a recent publication on the methods paper, looking at a new initiative by the FDA, to potentially approve therapies based on patient reported outcomes, rather than just heart mortality and morbidity outcomes, so we're really excited about the innovations, and the Heart Failure Space, the work that describes where we're going as a field and as a profession. You'll see some features coming up in the journal, from opinion leaders across the globe on where this specialty sits in 2019, and where we, as the leaders in the field, can guide it as we move into our next decade, and I think that some of the most exciting work the journals doing.

Dr Amit Khera:                  Thank you, Dr Sweitzer. We really appreciate your time today for the podcast, and your insights on the Journal.

Dr Robert Gropler:          Good afternoon, I'm Rob Gropler. I'm the Editor-in-Chief of Circulation Cardiovascular Imaging. It's one of the journals within the family of Circulation Journals, and our focus is really on being the most influential source of leading edge imaging sciences, as it relates to transforming cardiovascular care, so what that means is, that we're interested in all imaging studies that are applied to the care of the cardiovascular patient, and although our primary focus is really on clinicians, and researchers, but we also want to expand our viewership, if you will, to anyone who is interested in how imaging is used to understand Cardiovascular Medicine, and to treat patients with Cardiovascular Disease. So, we are edged in all forms of imaging, this can be from MR, to echo, to nuclear, to CPT, to optical imaging, it involves all types of disease, ranging from Congenital Heart Disease, up to diseases in the elderly, it also involves not just it is in humans, but also understanding disease in the preclinical space, particularly as it helps us understand new technologies that may ultimately reach human use, either for investigational purposes, or ultimately, to be used in the treatment of a patient with Cardiovascular Disease.

Dr Amit Khera:                  What are some innovative things you and the Journal are planning for this year?

Dr Robert Gropler:          We're doing quite a few things. One of the first things we did, as you know, were relatively new, where we've only been an editorial team, if you will, for one year. One of the major efforts has been to increase our presence, in terms of digital media strategies, across the board. And so, this meant expand our Twitter presence, if you will. It also meant increasing our offerings in that digital space by, for example, having a journal club, what we would do is on a every other month basis, discuss a paper we published that's of significant interest via Twitter. And it would involve the authors, the associate editors who actually manage that study, as well as the editorialist who wrote about that study, and it leads to very unique insights into how that paper is being viewed by the scientific community at large, and also potentially how that information will be implemented in terms of transforming clinical care.

                                                We've added what we call a teaching file. If you think about imagers, imagers learn by seeing images. And the more they can see images, put them in the context of clinical cases, the more they understand what an image means when they see it. So, what we do now is we accept a large number of what we call imaging cases. These are specific unique cases that have a history, and then a short write up about them.

                                                And those are gathered each month, but then they're downloaded into a file. And then, anyone with access to the Journal can then look at, use to learn from, to potentially use for talks to enhance their own education the education of others. And we have found that to be, again, another offering that our readers particularly like.

Dr Amit Khera:                  And how do you see Circulation Cardiovascular Imaging advancing the mission of imaging, which seems to be ever-expanding, and ever-growing?

Dr Robert Gropler:          We're really in the education business. And what that means is that we're educating at a multi-scale level. Just educating a practitioner on what technology can do, how it's helping cardiovascular medicine, yes, that's important. But what we're also doing, is we're educating the scientists as to here as some of the new findings that were coming out because of imaging. And then that, in turn, will help direct them or signal them as to where is the science leading them, and what should be their next steps?

                                                We're also educating the general public as to what can imaging do, and how does imaging change cardiovascular medicine for the better, and what they can expect from that. And we're also educating the regulatory bodies, if you will, that determine what imaging can be done in the clinical environment and so on, and the importance of these imaging techniques.

                                                So number one, I think we always have to maintain that focus, as to that's our goal. Now, that being said, I think the question becomes how do you convey that concept? And where we have to continually evolve.

                                                And I think they were very smart years ago to make it a digital-only journal, as opposed to combined print and digital. So, I think that was actually very savvy. But the digital net component now has to expand. And that means our offerings have to reflect not just that people learn in different ways, that is, we have to have not just, if you will, a didactic or print equivalent component of a paper. But it also should be audio-based, such as this podcast. But they also need to be varied as in terms of the types of offerings, and their brevity or length, if you will.

Dr Amit Khera:                  Thank you, Dr Robert Gropler, the Editor-in-Chief of Circulation Imaging. We really appreciate your time today.

Dr Robert Gropler:          Thank you very much. You have a great day.

Dr Amit Khera:                  Well, I'm sure you enjoyed this as I did. We really got incredible insight from the Editors-in-Chief of our Circulation family of journals. We learned so much about the broad array of subspecialties that they cover, and all the exciting and innovative things they're doing to really advance the missions of their fields, and also for the authors and for science.

                                                Well, again, I'm Amit Khera, associate editor from UT Southwestern, Digital Strategies editor for Circulation. And next week, you'll have your usual hosts, Carolyn Lam and Greg Hundley.

Dr Carolyn Lam:                This program is copyright American Heart Association 2019.