JACC Editor's Page

Two years into his role as Editor-in-Chief, Dr. Harlan Krumholz looks back on the journey that's shaped JACC, staying true to its mission while evolving to better serve authors and readers around the world. He shares what's driven the journal's growth into a truly international platform and offers a glimpse of where he sees JACC heading next, as it continues to advance cardiovascular science and care on a global scale.

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JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, critiques the current physician certification system, arguing it is outdated, misaligned with real-world clinical practice, and contributes to physician burnout without clear evidence of improved patient outcomes.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.