JAMA Cardiology—The Year in Review, 2021

After the unprecedented volume of manuscript submissions in 2020 addressing the COVID-19 pandemic and its cardiovascular complications—with more than 900 COVID-19–related manuscripts submitted to JAMA Cardiology from March through December that year—life for journal editors slowly returned to normal in 2021, but not completely. We continued to receive a large number of submissions related to COVID-19, many of which provided insights into the evolving cardiovascular sequelae and, notably, the potential complications associated with the new vaccines against the SARS-CoV-2 virus. The articles^1-3 we published on these topics received the largest number of views and downloads and the highest Altmetric scores (measures of news and social media coverage)^1,2,4; in addition, some were included in the top 3 Web of Science citations (Table).^1,5,6 Importantly, we were also able to maintain our focus on our core mission: to publish the best cutting-edge Original Investigations, Reviews, and opinions spanning the universe of cardiovascular science. In addition to covering topics related to management of acute and chronic coronary artery disease, heart failure, arrhythmias, and valvular heart disease, as well as prevention of heart disease, the journal published timely articles addressing the genetics of cardiomyopathies, atrial fibrillation, and sudden death; posttraumatic stress disorder; maternal health; and health equity and the social determinants of health.

Table.  JAMA Cardiology Statistics for 2021

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In the past year, the journal received 2538 manuscripts (Table), of which 312 (12.3%) addressed topics related to COVID-19. The acceptance rates of 10% for all submissions and 6% for original science manuscripts are on par with the other major journals in our field. We remain a global journal with more than 60% of our submissions arriving from outside the US. JAMA Cardiology had a further increase in impact factor to 14.7, which is reported for 2020, compared with 12.8 reported for 2019. The immediacy index of 25.14 ranks JAMA Cardiology very high among cardiovascular journals.

Our weekly online content was delivered to more than 72 000 readers, with more than 4.9 million article views and downloads. The number of readers who follow us on social media has increased to more than 96 000. Our section on cardiovascular images has a particularly notable online presence. Our monthly podcast discussions with authors remain topical and highly popular.⁷ The close linkage of JAMA Cardiology with JAMA and the other JAMA Network journals continues to connect us to the dedicated editorial and publication staff who facilitate the dissemination of our weekly and monthly content online, in print, and through multimedia channels. Articles published in JAMA Cardiology received more than 6700 mentions in news media in 2021.

Although it is difficult to single out the most notable articles that we have published in the last 12 months, several are distinguished by the high level of interest and notoriety they achieved among our readership (Table). Montgomery et al¹ were among the first to report a case series of myocarditis after vaccination against COVID-19 with the novel messenger RNA (mRNA) vaccines, in which 23 previously healthy men in the US Military Health System experienced myocarditis within 4 days of receiving either the BNT162b2-mRNA (Pfizer-BioNTech) or the mRNA-1273 (Moderna) vaccine. All patients received brief supportive care and had recovered or were recovering at the time of this report. The Military Health System administered more than 2.8 million doses of mRNA COVID-19 vaccine during the time frame of this study (January 1-April 30, 2021). The findings of this study identified many of the pertinent characteristics of mRNA vaccine–related myocarditis that were confirmed in subsequent larger series and reports from the US Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System (VAERS). The event rate is very low, but young men are most susceptible, most commonly after the second dose of the vaccine, and most have benign clinical courses that resolve with supportive care. This report was accompanied by an editorial by Shay et al³ from the CDC who described the VAERS surveillance program and emphasized that the potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, after COVID-19 infection. Subsequently, Dionne et al² described 15 adolescent patients (14 male [93.3%]) who were hospitalized between May 1 and July 15, 2021, with myocarditis after receiving the BNT162b2 vaccine. Symptoms began after the second dose in all but 1 patient, and short-term follow-up symptoms had resolved in 11 patients. This report once more identified younger age and male sex as higher risk factors for this complication. The authors emphasized that the long-term risks associated with postvaccination myocarditis remain unknown and require further investigation.

Two other highly notable articles in 2021 addressed the prevalence and clinical implications of myocarditis after COVID-19 infection among competitive athletes and the issues regarding safe return to competition. Rajpal et al⁵ studied 26 competitive college athletes with recent COVID-19 infection using cardiac magnetic resonance (CMR) imaging and reported that 4 (15.4%) had CMR findings suggestive of myocarditis and 8 additional athletes (30.8%) exhibited late gadolinium enhancement without T2 elevation, which is suggestive of prior myocardial injury. Although the implications of COVID-19–related myocardial injury in competitive athletes and related sports participation remains unclear, this study suggested that CMR has the potential to risk stratify athletes for safe participation. Subsequently, Daniels et al⁴ reported a larger multicenter series of 1597 athletes (964 men [60.4%]) representing 13 universities who were studied after recovery from COVID-19 infection. The authors reported that 37 athletes (2.3%) were diagnosed with COVID-19 myocarditis, of whom 9 (24.3%) had clinical myocarditis and 28 (75.7%) had subclinical myocarditis. Compared with symptoms alone, CMR imaging for all athletes yielded a 7.4-fold increase in the detection of myocarditis. Follow-up CMR imaging performed in 27 of those with myocarditis (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%). A third report by Martinez et al⁸ recommended a more nuanced approach to screening competitive athletes after COVID-19 infection. This study pooled data in athletes with recent COVID-19 infection among the major North American professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men’s and women’s National Basketball Association). The leagues had implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 before resumption of team-organized sports activities. Screening included troponin testing, electrocardiography, and echocardiography, and more advanced testing (CMR and/or stress echocardiography) was performed only in those with abnormal screening results. Among 789 professional athletes (777 men [98.5%]) with previous COVID-19 infection, abnormal screening results were identified in 30 athletes (3.8%) necessitating additional testing. Only 5 athletes (0.6%) ultimately had CMR imaging findings, which suggested inflammatory heart disease (3 myocarditis, 2 pericarditis) that resulted in restriction from play. No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation. With this staged approach, safe return to professional sports activity has been thus far achieved.

The most highly cited article in 2021 unrelated to COVID-19 was an excellent meta-analysis by McGuire et al⁶ addressing the association of sodium-glucose cotransporter 2 (SGLT2) inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes. Compiling the data from 6 randomized trials, the authors reported that SGLT2 inhibitors were associated with a reduced risk of major adverse cardiovascular events but with significant heterogeneity in associations with cardiovascular death. The largest benefit across the class was for an associated reduction in risk for heart failure hospitalization and kidney outcomes, with benefits for risk of heart failure hospitalization being the most consistent observation across the trials.

The editors sincerely appreciate the hundreds of our colleagues who have served as peer reviewers in 2021 (their names are listed elsewhere),⁹ and we thank them for volunteering their time, effort, and insightful critiques that are essential in helping the editors select manuscripts with the highest priority for publication. We, of course, are most grateful for our authors who have found a home in submitting their work to JAMA Cardiology and for those invited to author editorials and commentaries that enhance our content by placing our most notable articles in context with current and future trends in the field. The contributions of our authors remain the backbone of the journal.

Editing a scientific journal is a collegial enterprise, and we have forged a cohesive team of deputy and associate editors dedicated to working together with authors to advance scientific discovery and discourse. We look forward in 2022 to maintaining the momentum we have created in our first 6 years of publishing that has positioned us among the premier journals in our discipline.

Corresponding Author: Robert O. Bonow, MD, MS, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 600, Chicago, IL 60611 (robert.bonow@nm.org).

Published Online: March 23, 2022. doi:10.1001/jamacardio.2022.0212

Conflict of Interest Disclosures: None reported.