Accepted Manuscript

Open Access Publishing and Subsequent Citations Among

Articles in Major Cardiovascular Journals

Ravi B. Patel, Muthiah Vaduganathan, Ramya C. Mosarla,

Ramkumar V. Venkateswaran, Deepak L. Bhatt, Robert O. Bonow

PII: S0002-9343(19)30173-1
DOI: https://doi.org/10.1016/j.amjmed.2019.02.009
Reference: AJM 15033
To appear in: The American Journal of Medicine

Please cite this article as: R.B. Patel, M. Vaduganathan, R.C. Mosarla, et al., Open Access
Publishing and Subsequent Citations Among Articles in Major Cardiovascular Journals,
The American Journal of Medicine, https://doi.org/10.1016/j.amjmed.2019.02.009

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Open Access Publishing and Subsequent Citations Among Articles in Major

Cardiovascular Journals
Brief Title: Open Access and Citation Volume

Ravi B. Patel MD (1)*, Muthiah Vaduganathan MD MPH (2)*, Ramya C. Mosarla MD (3),
Ramkumar V. Venkateswaran MD (2), Deepak L. Bhatt MD MPH (2), Robert O. Bonow MD
MS (1)

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(1) Division of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, IL

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(2) Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School,
Boston, MA

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(3) Department of Medicine, Massachusetts General Hospital, Boston, MA

*Contributed equally as co-first authors.

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Article Type: Brief Observation
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Word Count: 1,215

Address for Correspondence:

Ravi B. Patel, MD, Division of Cardiology, Department of Medicine, Northwestern University
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Feinberg School of Medicine, 676 N. St Clair St, Suite 600, Chicago, IL 60611, Tel: (312) 503-
5779, Fax: (312) 695-0063, Email: ravi.patel@northwestern.edu
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Funding: Dr. Ravi Patel is supported by the NHLBI T32 postdoctoral training grant
(T32HL069771).
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Disclosures: Dr. Ravi Patel is supported by the NHLBI T32 postdoctoral training grant
(T32HL069771). Dr. Muthiah Vaduganathan is supported by the KL2/Catalyst Medical Research
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Investigator Training award from Harvard Catalyst | The Harvard Clinical and Translational
Science Center (NIH/NCATS Award UL 1TR002541), and serves on advisory boards for
AstraZeneca, Bayer AG, and Baxter Healthcare. Dr. Deepak L. Bhatt discloses the following
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relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape

Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of
Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight
Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly
Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now
Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of
Medicine, Population Health Research Institute; Honoraria: American College of Cardiology
(Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation
Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute;
RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir
Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical

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trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology),
Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population
Health Research Institute (COMPASS clinical trial steering committee funded by Bayer), Slack
Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular
Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical
Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART
Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen,
AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest
Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron,

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Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor,

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Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator:
Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College

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of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. The
other authors report no relationships relevant to the contents of this paper to disclose.

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Key Words: open access; publishing; citations; cardiology; journal

All authors had access to the data and had a role in writing the manuscript.
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Abstract

Background: While open access publishing among cardiovascular journals has increased in

scope over the last decade, the relationship between open access and article citation volume

remains unclear.

Methods: We evaluated the association between open access publishing and citation number in

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2017 among 4 major cardiovascular journals. Articles indexed to PubMed with ≥5 citations were

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identified among the following journals: Circulation, European Heart Journal, Journal of the

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American College of Cardiology, and JAMA Cardiology. Multivariable Poisson regression

models were adjusted for journal and article type.

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Results: Of the 916 articles published in 2017, original investigations accounted for most articles
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(66.7%), followed by reviews (14.5%), guideline/scientific statements (8.4%), research letters

(3.7%), viewpoints (3.7%), and editorials (2.9%). Among all articles, 43% (n=391) were open
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access. Citation number was higher among open access articles compared with those with
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subscription access (14 [25th-75th percentile: 9-23] vs. 11 [25th-75th percentile: 7-17]; P<0.001).

Open access status was significantly associated with higher number of citations after
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multivariable adjustment (β coefficient: +0.42, 95% CI: 0.38-0.45, P<0.001). Open access
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articles had consistently higher citations compared with subscription access articles across the 3

most frequent article types.

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Conclusion: Among contemporary articles published in major cardiovascular journals, open

access publishing account for over 40% of articles and was significantly associated with

increased short-term citations. Further research is required to assess the variation in long-term

citation rates based on open access publishing status.

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Open access, an avenue for widespread dissemination of scientific output, has become

increasingly common across the medical literature. Open access articles expanded 16-fold within

biomedical journals over an 11-year timespan, and may continue to grow as funding agencies

mandate unrestricted public access to research.1, 2 While open access provides increased

availability of scientific output, its relationship to article citation volume remains unclear.3, 4 We

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evaluated the association between open access status and citation number among articles

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published in major cardiovascular journals in 2017.

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We utilized Dimensions, a searchable digital research infrastructure that aggregates data

from over 97 million publications,5 to identify articles indexed on PubMed with ≥5 citations

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published in 2017 among 4 major cardiovascular journals (Circulation, European Heart Journal,
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Journal of the American College of Cardiology, and JAMA Cardiology). Information regarding

publishing status and number of citations was available through Dimensions. Abstracts and full-
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texts were reviewed to extract data regarding article type, article topic, and study design.
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The association between open access status and number of citations was assessed using

multivariable Poisson regression models adjusting for journal and article type. To limit potential
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for undue influence of guidelines/scientific statements, sensitivity analysis was performed

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excluding this article type. Analyses were carried out using R version 3.5.0 (R Foundation for

Statistical Computing).
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There were 916 articles published in 2017 with 5 or more citations at the time of search

query (August 13, 2018). Original investigations accounted for most articles (66.7%), followed

by reviews (14.5%), guideline/scientific statements (8.4%), research letters (3.7%), viewpoints

(3.7%), and editorials (2.9%). Observational studies (76.1%) were the most common design

among original investigations/research letters. The most frequent article topics were: coronary

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artery disease (23%), heart failure/cardiomyopathy (19%), electrophysiology (15%), and valve

disease (9%).

Overall median number of citations was 12 (25th-75th percentile: 8 - 20) and 43% (n=391)

were open access. Median number of citations was higher among open access articles compared

with those with subscription access (14 [25th-75th percentile: 9-23] vs. 11 [25th-75th percentile: 7-

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17]; P<0.001). Open access articles had consistently higher citations compared with subscription

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access articles across the 3 most frequent article types (original investigations, reviews,

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guidelines/scientific statements) (Figure 1). Open access status was significantly associated with

higher number of citations after adjusting for journal and article type (β coefficient: +0.42, 95%

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CI: 0.38-0.45, P<0.001) (Figure 1). Comparable association with citation volume was observed
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in sensitivity analysis excluding guidelines/scientific statements (adjusted β-coefficient +0.31,

95% CI: 0.28-0.35, P<0.001). Compared with original investigations, research letters, editorials,
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and viewpoints were associated with fewer citations, while guideline documents/scientific
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statements were associated with higher citations (adjusted P<0.001 for all comparisons). There

was no significant difference in citation number between review articles compared with original
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investigations (adjusted β coefficient: -0.03, 95% CI: -0.08-0.02, P=0.19). Goodness-of-fit

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testing revealed significant residual deviance of the model (residual deviance: 15984, degrees of

freedom: 906, P<0.001).

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We described the relationship between open access status and subsequent citations

among articles published in 2017 in 4 major cardiovascular journals. Open access articles

accounted for over 40% of articles and were more commonly original investigations. Open

access status was independently associated with higher short-term citation number after adjusting

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for article characteristics. In aggregate, citation rate was 1.5 times higher for open access articles

compared with those without open access.

Given the costs of open access publication and the importance of citations to journals,

academic institutions, and individual researchers, there is interest in understanding the

relationship between these 2 entities. Studies have previously evaluated the impact of open

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access status on citation rate in other fields of medicine, yielding variable findings. A trial within

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11 physiology journals that randomized articles to open or subscription access revealed that

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while open access status resulted in increased readership, there was no observed effect on overall

citation rate.4 It is unclear whether the findings of this trial extend to the current academic

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climate, in which open access publishing has continued to expand, or to cardiovascular
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publications specifically.

Our study has limitations. Despite multivariable accounting, our model showed overall
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poor fit with observed citation rate. Unmeasured factors likely explain the high degree of
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residual deviance of our model. Specifically, it is likely that overall scientific merit of articles

may be a primary unmeasured confounder and cannot be captured through traditional metrics.
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Funding source, which may have a role in both publishing status and citation number, was not
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readily captured through the Dimensions dataset at the time of search query. Indeed, since the

establishment of the of the National Institute of Health (NIH) public access policy, more than
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100,000 NIH-funded manuscripts are deposited to PubMed Central annually.6 As such work has

previously undergone a rigorous grant-level peer review process, articles generated from

government or societal funding that require open access may be of increased interest to the

academic community, and thus may result in higher citation rates. Due to the relative recency of

article publication, there may not have been sufficient time for accrual of citations. Finally, it is

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possible that these journals utilized mechanisms of open access that were not identified by

Dimensions.

Among contemporary articles in 4 major cardiovascular journals, open access status is

independently associated with higher short-term citation rates. Future efforts are needed to better

understand variation in citation patterns and to continue to expand and make affordable open

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access publishing platforms as a means to disseminate scientific information.

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References

1. Laakso M, Bjork BC. Anatomy of open access publishing: a study of longitudinal

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development and internal structure. BMC Med. 2012;10:124.
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2. Wellcome Trust Open Access Policy. https://wellcome.ac.uk/funding/guidance/open-

access. Accessed October 26, 2018.

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3. Eysenbach G. Citation advantage of open access articles. PLoS Biol. 2006;4:e157.

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4. Davis PM, Lewenstein BV, Simon DH, Booth JG, Connolly MJ. Open access publishing,

article downloads, and citations: randomised controlled trial. BMJ. 2008;337:a568.

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5. Dimensions. https://www.dimensions.ai/. Accessed August 13, 2018.

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6. Topper L, Boehr D. Publishing trends of journals with manuscripts in PubMed Central:

changes from 2008-2009 to 2015-2016. J Med Libr Assoc. 2018;106:445-454.

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Figure Legends

Figure 1. Association between Open Access Status and Number of Citations. Each data point

represents a single article. Citation number was highly skewed and was natural log-transformed

for display purposes and analyzed using multivariable Poisson regression (adjusting for journal

and article type). Number of articles and citations by publishing status and article type are

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displayed below the figure.

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Clinical Significance

 Open access publishing has expanded over the last decade as several funding agencies

have mandated unrestricted access to scientific output.

 Among contemporary articles published in major cardiovascular journals, open access

publishing is common, accounting for over 40% of articles.

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 Open access publishing is significantly associated with increased short-term citation

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number, independent of article type and journal of publication.

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Figure 1