EDITOR'S PAGE
International cardiology
Anthony N. DeMaria, MD, MACC*,1
* Address correspondence to: Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122, USA.
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Anthony N. DeMaria MD
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I had the opportunity to attend the most recent meeting of the European Society of Cardiology held in Berlin, Germany. By all accounts, the meeting was a huge success. Attendance was said to be in excess of 20,000 individuals. The program was comprised of both clinical investigation and basic research, and it included new data from recent clinical trials. The meeting gave clear evidence of the productivity of non-U.S. investigators and the international nature of contemporary cardiology.
The emerging contributions of the international cardiovascular community have important implications for JACC. The most striking effect of the productivity of non-U.S. cardiologists is in the number of submissions to the Journal. In the eight months since the Editorial Office has moved to San Diego, papers from the U.S. have accounted for approximately 36% of submissions, while 64% have come from outside the country. Thus, we have reached the point that JACC receives nearly two papers from international authors for every one it receives from U.S. authors.
The specific countries from which manuscripts have originated are listed in Table 1. As can be seen, papers have been received from throughout the world. Japan was the country that accounted for the largest number of submissions, with significant numbers coming from Canada, Australia, and Israel. However, the European countries, in aggregate, accounted for the largest number of international submissions to JACC. Italy, Germany, and Great Britain led the way in European submissions.
It is apparent that JACC is truly an international journal of cardiology. As such, we have a responsibility to our non-American colleagues. Assuming that the submission of papers reflects readership, the Journal must take into account the needs and interests of the cardiovascular community outside the U.S. The major scientific issues confronting the foreign community generally mirror issues in the U.S. There are, of course, some basic differences involving the prevalence of disease states and the socioeconomic influences on the delivery of health care. In addition, the greater interest in, access to, and reliance on sophisticated technology distinguish cardiovascular specialists in the U.S. from some of those outside the country. Accordingly, in selecting content for JACC it is important that the Editors be cognizant of and responsive to these special needs and interests. It is therefore to be anticipated that JACC may publish some high-quality papers addressing issues not often confronted by U.S. cardiovascular specialists.
In a similar vein, it is important for the non-U.S. cardiovascular community to play a greater role in the peer-review process. JACC is on track to receive 15% more submissions in the current calendar year than we did last year. We are dependent on the international cardiovascular community to review and evaluate papers—a dependence likely to increase in the future. It is appropriate, therefore, that our colleagues from outside the U.S. play an important role on the Editorial Board and provide input into the policies of the Journal, as do their American counterparts. To this end, we intend to extend invitations to serve on the Editorial Board to a greater number of foreign cardiovascular specialists and proactively seek their opinion about issues relating to the Journal.
The greater number of submissions to JACC from the international community raises interesting issues regarding research within the U.S. as well as abroad. Clearly, much of the increase in manuscripts submitted from outside the U.S. represents a natural expansion of the biomedical research enterprise proportional to the economic development abroad. It is likely that the current ratio of submissions more accurately represents the world-wide proportion of cardiovascular specialists located in the U.S. versus outside the country. However, one cannot dismiss the possibility that research productivity, particularly clinical investigation, is not growing as rapidly in the U.S.
There are, of course, a number of differences between medicine in the U.S. and medicine abroad that could contribute to the ease of carrying out clinical research. The greater regionalization of medical facilities overseas seems to make patient enrollment in clinical studies somewhat easier. In addition, the administrative requirements may be less, the process of informed consent may differ, and patients abroad may have a more compliant attitude with regard to participating in research protocols. However, the sense that clinical research in the U.S. has been contracting due to diminishing financial support has been pervasive for several years. This is an important issue—one that will be addressed in a future Editor’s Page.
Research contributions to JACC are increasing rapidly from authors outside the U.S. The increasing productivity and contributions of the international cardiovascular community are cause for celebration. Non-U.S. authors and their manuscripts have added substantially to the quality of JACC. Just as we hope that the increasing number of non-U.S. cardiologists who are obtaining Fellowship in the American College of Cardiology identify closely with the organization, so we hope that the overseas contributors to JACC feel some sense of ownership of the Journal. The greater role of international contributions to JACC can be expected to influence the content of the Journal and is strong evidence of the international character that cardiovascular research has assumed.
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Footnotes
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1 Editor-in-Chief, Journal of the American College of Cardiology 
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