JACC Editor's Page

Dr. Harlan Krumholz reflects on the profound impact of experiencing a patient's death for the first time, describing how medical training often leaves clinicians unprepared for the emotional and communicative challenges that follow. Over time, he developed a compassionate framework for speaking with grieving families—honoring the deceased, reassuring them about suffering, releasing them from guilt, and recognizing the love present—to help shape how loss is experienced and remembered. He urges physicians to share their own stories of patient loss, emphasizing that medicine is not only about prolonging life but also about caring deeply and meaningfully when life ends.

In this week's Editor's Page, Dr. Harlan Krumholz introduces Dr. Milton Packer's adipokine hypothesis, which proposes that dysfunctional visceral fat and the adipokines it secretes are central to the development of heart failure with preserved ejection fraction (HFpEF). This framework suggests that the benefits of therapies like GLP-1 receptor agonists and SGLT2 inhibitors may stem partly from restoring balance in adipose–cardiac signaling, offering a biologically grounded model for a condition long marked by therapeutic frustration. While the hypothesis is ambitious and unproven, it provides a coherent structure for future research and exemplifies how bold, integrative thinking can advance medical understanding.

In the Editor's Page for the JACC October 14, 2025 issue, JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, critiques the current physician certification system, arguing it is outdated, misaligned with real-world clinical practice, and contributes to physician burnout without clear evidence of improved patient outcomes. He proposes a modernized, two-tiered framework for certification—distinguishing between essential, instantly recallable knowledge (Type 1) and complex, reasoning-based skills (Type 2)—that emphasizes continuous learning, relevance, and support over high-stakes testing.

In this week's Editor's Page, Dr Harlan Krumholz explains how the rise of AI writing tools marks a turning point in scientific communication, offering support for grammar, clarity, and structure—especially benefiting those less fluent in English or academic conventions. 

Artificial intelligence is rapidly transforming cardiovascular medicine, offering breakthroughs in diagnosis, treatment personalization, and research acceleration. However, its responsible integration requires guiding principles: focusing on clinical problems over technology, rigorous evaluation, bias mitigation, thoughtful implementation, and building trust. If applied wisely, AI can become a powerful partner in advancing equitable and effective cardiovascular care.

In June 2025, the White House introduced "Gold Standard Science" principles to enhance the rigor, transparency, and trustworthiness of federally funded research—values long embraced by top journals like JACC. These include reproducibility, openness to null results, interdisciplinary collaboration, and unbiased peer review, all of which align with JACC's ongoing commitment to scientific integrity. The journal is advancing efforts to improve transparency, peer review, and reproducibility through clearer data policies, stronger editorial oversight, and new tools like AI to support integrity and efficiency. Ultimately, JACC views these principles not as a shift, but as a reaffirmation of its mission to uphold scientific excellence while remaining independent, accountable, and open to challenge and debate.

This week's Editor's Page outlines JACC's expectations for AI research manuscripts in cardiovascular care, emphasizing the need for clinical relevance, real-world feasibility, and responsible evaluation beyond retrospective model performance. We present a framework focusing on three core domains: addressing a genuine clinical need, using fit-for-purpose evaluation methods across different development stages, and ensuring transparency, interpretability, and reproducibility. JACC prioritizes submissions that demonstrate real-world impact, responsible innovation, and a clear path to improving patient care—especially those that go beyond early model development.

JACC's September 2 issue features a new editor's page from Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC. In it, he brings up a troubling stagnation and reversal in U.S. cardiovascular health progress since 2010, despite advances in medical treatments and increased healthcare spending.  Click here to listen to this call for a shift from individual interventions to systemic accountability, equity, and prevention, urging a bold, coordinated effort to improve population-level outcomes and close persistent disparities.

This update to the JACC Report Card highlights ongoing disparities in cardiovascular mortality between Black and White Americans. While some metrics, such as ischemic heart disease, show modest improvement, excess age-adjusted mortality rates and years of potential life lost remain alarmingly high for Black Americans. These findings reinforce the urgent need for structural reform, sustained investment, and accountability to close persistent gaps in cardiovascular outcomes.

Cardiovascular devices are at the heart of modern clinical practice, yet gaps in surveillance, reporting, and clinician awareness continue to pose serious risks to patient safety. This week's Editor's Page highlights the urgent need for improved transparency, stronger reporting systems, and clinician-led engagement around device recalls. With expert perspectives on FDA oversight, the role of unique device identifiers (UDI), and opportunities for real-time communication and consensus-building, this commentary challenges the cardiovascular community to take an active role in shaping the future of device safety. By addressing long-standing misconceptions and systemic limitations, it calls for smarter systems, faster responses, and shared accountability in delivering safe and effective cardiovascular care.

Therapeutic breakthroughs in ATTR cardiomyopathy have ushered in a new era of treatment, with gene silencers, stabilizers, and next-generation therapies extending life and improving quality for patients once left with few options. Yet this progress has exposed a profound and growing divide—between innovation and access. This week's Editor's Page explores the striking disconnect between clinical value and global affordability, calling attention to pricing challenges, equity gaps, and the real-world implications of cost-based care limitations. By highlighting the urgency of equitable implementation alongside scientific success, the issue urges clinicians, manufacturers, policymakers, and journals to work together in shaping a future where life-changing therapies reach all who need them.

This issue of JACC showcases a diverse yet thematically cohesive collection of articles that explore the complexities of cardiovascular medicine, from ethical dilemmas and patient-reported outcomes to emerging therapies and methodological innovations. Highlights include a poignant HeartBeats essay on the emotional weight of clinical decisions, debates on responder analyses, promising data on Factor XI inhibitors, and groundbreaking registry findings on balloon pulmonary angioplasty. The issue also features insights into risk prediction, statistical modeling in heart failure trials, rare case reports, and a continued commitment to ethically grounded anatomical education.

This special lipid-themed issue of JACC emphasizes the importance of innovative research in lipid disorders to reduce cardiovascular risk, highlighting studies that extend our understanding of lipid biology and evaluate new treatments. Key reviews and original investigations explore novel lipid-modifying therapies, such as RNA interference and antibody therapies, demonstrating their potential in managing complex lipid disorders. The issue also includes editorials and case studies that provide critical context and underscore the need for personalized and mechanism-driven approaches in lipid management.

In a time of rising global tensions, JACC reaffirms its commitment to science as a unifying, borderless force—advocating for truth, equity, and collaboration to improve health worldwide. By fostering inclusive research, promoting open dialogue, and resisting politicization, JACC aims to build a global medical community working together to overcome disease and conflict.

Listen to the editor's page for this special issue of JACC focusing on key advancements in electrophysiology, including studies on atrial fibrillation prevention, pulsed field ablation, sudden cardiac arrest in young athletes, and efforts to reduce defibrillator use in congenital heart disease. Join Editor-in-Chief Harlan Krumholz as he covers pacemaker safety, device surveillance—including insights from former FDA Commissioner Robert Califf—and emerging topics like AI monitoring and ablation mapping strategies.

Listen to the editor's page for this special issue of JACC focusing on advancing the understanding and treatment of cardiogenic shock through pivotal clinical trials, expert consensus statements, and state-of-the-art reviews aimed at improving patient outcomes. Join Editor-in-Chief Harlan Krumholz as he highlights key contributions like the Altshock-2 trial and new ACC guidelines, the issue underscores the journal's commitment to leading cardiovascular care in this complex field.

Listen to the editor's page of the April 14th JACC issue for a discussion about the staggering toll of cardiovascular disease on Black Americans, revealing nearly 800,000 excess deaths and 23.7 million years of potential life lost over two decades. Join Editor-in-Chief Harlan Krumholz as he explores the systemic roots of these disparities and calls for urgent, collective action to turn data into justice.

In a rapidly changing world marked by societal divisions, technological advances in healthcare, and shifting views on expertise, the JACC Journals remain dedicated to advancing global cardiovascular health through a science-based and humanistic approach. Committed to evidence, integrity, and humanity, JACC focuses on rigorously evaluating research, guided by facts rather than ideology, and strives to address healthcare inequities while respecting patient autonomy. As a trusted platform, it emphasizes collaboration, innovation, and inclusivity to improve cardiovascular health worldwide. By providing actionable science for clinicians and accessible insights for patients, the JACC Journals aim to lead the way in advancing cardiovascular medicine, fostering trust, and making a lasting impact on global health.

Listen to the editor's page of the March 25th JACC issue, in which Harlan M. Krumholz, MD, SM, FACC, highlights how cardiac electrophysiology is undergoing significant transformation driven by technological advancements and evolving treatment strategies. Key topics include long-term insights from the AMPLATZER Amulet trial, the role of intracardiac electrograms in ventricular tachycardia ablation, and shifting anticoagulation strategies in atrial fibrillation. The issue also emphasizes the growing role of device-based therapies, such as leadless pacemakers, and explores the intersection of electrophysiology with structural cardiology and precision medicine.

This special lipid-themed issue of JACC emphasizes the importance of innovative research in lipid disorders to reduce cardiovascular risk, highlighting studies that extend our understanding of lipid biology and evaluate new treatments. Key reviews and original investigations explore novel lipid-modifying therapies, such as RNA interference and antibody therapies, demonstrating their potential in managing complex lipid disorders. The issue also includes editorials and case studies that provide critical context and underscore the need for personalized and mechanism-driven approaches in lipid management.

In this issue of JACC, we explore the evolving landscape of cardiovascular care, where one-size-fits-all approaches are giving way to precision strategies rooted in individual variation. From redefining diagnostic thresholds to tailoring surveillance based on genetics and patient context, these studies illuminate a future where nuance, not averages, drives better outcomes. Join us as we unpack the science behind a more personalized, data-informed vision of heart health.

In this heartfelt reflection on their first year as editor of JACC, Harlan Krumholz shares how listening—to authors, reviewers, readers, and the broader medical community—has revealed a deep yearning for connection, trust, and purpose in cardiovascular science. It's a call to action: to shape the future of medicine with integrity, inclusivity, and hope, and to lead not just with data, but with values that inspire and unite.

Interventional cardiology is rapidly evolving, with advances in imaging, devices, and techniques driving both innovation and rising expectations for safety and patient-centered outcomes. This week's editor's page highlights cutting-edge research and expert commentary on topics such as plaque vulnerability, stent performance, imaging-guided interventions, and long-term outcomes, reflecting both progress and ongoing challenges in the field. By bringing together this wealth of new science, the issue aims to inform clinical practice, encourage thoughtful decision-making, and inspire continued innovation in cardiovascular care.

Cardiac electrophysiology is rapidly evolving, blending procedural expertise with innovations in pharmacotherapy, device design, and lifestyle medicine. This week's Editor's Page spotlights key studies from JACC that challenge long-standing practices—from lifestyle strategies for atrial fibrillation to the role of defibrillation testing and device comparisons. We also explore disparities in cardiac arrest outcomes and complex real-world cases that push clinical boundaries. Tune in for a dynamic look at the future of arrhythmia care.