European Heart Journal 'Under Review': What Each Status Means

Before the paper reaches external reviewers, the European Heart Journal Editorial Board assesses initial priority and the handling editor evaluates cardiology-significance. About 70 percent of submissions are rejected at this stage. A desk rejection most often means the Editorial Board concluded that the work would fit better at a sister ESC journal (European Heart Journal Open for open-access cascade, EHJ-Cardiovascular Imaging for imaging specialty, EHJ-Quality of Care and Clinical Outcomes for outcomes specialty, EHJ-Cardiovascular Pharmacotherapy for pharmacology), or that the cardiology-priority bar is not met. Single-center observational studies face desk rejection at approximately 90 percent rates regardless of statistical quality.

The European Heart Journal editorial office confirms files are complete: manuscript with figures embedded, supplementary information separate, CONSORT checklist for clinical trials (required), reporting checklists where applicable (STROBE for observational studies, PRISMA for systematic reviews), cover letter directed to the editor, conflict-of-interest declarations, ethics-statement documentation, IRB approvals, trial-registration documentation, and data-availability statement.

The Editorial Board evaluates whether the submission meets European Heart Journal's priority bar and whether the paper should be considered for further review or returned (potentially with a suggestion to submit to another ESC journal).

In parallel with the Editorial Board's initial assessment, ambiguous-fit papers are discussed across the ESC editorial team where peer Editorial Board members weigh in on whether the paper would fit better at European Heart Journal flagship or at sister ESC journals. This editorial-team discussion runs alongside the assessment and adds 3 to 7 days to the timeline that is invisible to the author in the portal.

Papers that pass the Editorial Board initial assessment are passed to a handling editor who evaluates cardiology-significance, methodological rigor, and statistical adequacy. The handling editor oversees peer review and recommends a final decision.

European Heart Journal handling editors typically invite 2 to 3 external reviewers, with reviewer recruitment typically taking 7 to 14 days. The recruitment window can take longer because reviewers with topic-matched cardiology subspecialty expertise (especially across interventional, electrophysiology, heart failure, prevention, and basic-translational boundaries) are scarce.

Once reviewers agree to review, the typical European Heart Journal peer-review cycle lasts 2 to 6 weeks per reviewer with a 4.7-week first review round average. Reviewers are asked to evaluate cardiology-significance, methodological rigor, statistical methodology, CONSORT compliance for clinical trials, and reproducibility. Reviewer reports for European Heart Journal tend to be thorough; 2000 to 4000 word reports are typical.

After reports return, the handling editor synthesizes them and recommends a final decision. The Editor-in-Chief makes the final decision on the manuscript.

• Rejection within 1 to 14 days: Editorial Board initial assessment rejection.
• Rejection within 14 to 21 days: Handling editor desk rejection.
• Still Under Review after 3 weeks: Strong signal. Paper passed both the Editorial Board and handling editor filters.
• Still Under Review after 10 weeks: Reviewer-recruitment or reviewer-report delay. A polite inquiry via the ScholarOne portal is appropriate.
• Status changes to "Decision Pending": Reports are in; expect a decision within 1 to 2 weeks after EIC review.

This is the most common anxiety we hear from European Heart Journal authors during the active editorial window. The honest answer: no, 5 weeks at Under Review puts you right at European Heart Journal's 4.7-week first review round average. Reports may already be in editorial synthesis with the handling editor preparing the recommendation for the Editor-in-Chief. Most reviewer-driven delays come from reviewer-recruitment timing for cardiology subspecialty experts rather than slow reviews. If the portal still says Under Review at the 8-week mark, the most likely explanation is that one of the assigned reviewers asked for an extension and the handling editor granted it. This is normal practice at European Heart Journal.

What you should NOT do during the 5-to-8-week window is email the editorial office. European Heart Journal handling editors are working academic cardiologists managing 30+ active papers around their own clinical practice; an inquiry at 5 weeks adds friction without accelerating the timeline.

If your European Heart Journal paper is rejected after review, the natural cascade depends on what the reviewers and handling editor cited:

European Heart Journal Open is the natural OUP open-access cascade for cardiology papers where the priority bar of EHJ flagship is not met but the rigor is high. OUP supports manuscript-transfer with reviewer reports preserved.

EHJ-Cardiovascular Imaging is the ESC imaging specialty cascade.

EHJ-Cardiovascular Pharmacotherapy is the ESC pharmacology specialty cascade.

EHJ-Quality of Care and Clinical Outcomes is the ESC outcomes specialty cascade.

EHJ-Valvular and Structural Heart Disease is the ESC valvular specialty cascade.

Circulation is the external AHA top-tier cardiology cascade. Circulation uses ScholarOne at mc.manuscriptcentral.com/circulation; editorial contact circ@circulationjournal.org.

JACC is the external ACC cascade for top-tier cardiology. JACC uses ScholarOne at mc.manuscriptcentral.com/jacc; editorial contact jacc@elsevier.com.

OUP asks reviewers at European Heart Journal to evaluate four things specifically. The table below maps each to actionable preparation.

In our pre-submission work with European Heart Journal-targeted manuscripts, three named patterns generate the most consistent reviewer concerns and the most common reasons papers miss the editorial bar or fail the desk screen.

Single-center observational design flagged at Editorial Board screen. When the work is a single-center observational study without multi-center validation or pooled analysis, Editorial Board desk rejection within 2 weeks is common (single-center observational studies face desk rejection at ~90 percent rates regardless of statistical quality). The strongest manuscripts include multi-center validation or pooled analysis.

Narrow-subspecialty framing flagged at desk screen. When the introduction frames the work too narrowly within one cardiology subspecialty without broader-cardiology priority, handling editor desk rejection is common. The strongest manuscripts frame the broader cardiology relevance.

ESC family cascade offers from Editorial Board. When the Editorial Board concludes the work is rigorous but the cardiology priority bar of EHJ flagship is not met, transfer offers to European Heart Journal Open (open-access) or sister EHJ specialty journals are common. ESC editors take these transfers seriously.

This page was created from OUP's public European Heart Journal general instructions at academic.oup.com/eurheartj/pages/general_instructions, ESC editorial documentation (~70 percent desk rejection rate, 4.7-week first review round, single-center observational study ~90 percent desk rejection rate, single-anonymized peer review, Editorial Board + handling editor + EIC final-decision workflow), SciRev community-reported transit data on European Heart Journal, and Manusights pre-submission review experience with EHJ-targeted manuscripts.

For the cardiology landscape beyond European Heart Journal, see European Heart Journal Open (OUP open-access cascade), EHJ-Cardiovascular Imaging (imaging specialty), EHJ-Cardiovascular Pharmacotherapy (pharmacology specialty), EHJ-Quality of Care and Clinical Outcomes (outcomes specialty), EHJ-Valvular and Structural Heart Disease (valvular specialty), and external cardiology alternatives (Circulation, JACC, JAMA Cardiology, Lancet). The choice across these titles depends on whether the central contribution is top ESC cardiology (EHJ), OUP open-access cardiology (EHJ Open), specialty ESC scope (sister EHJ journals), top AHA cardiology (Circulation), top ACC cardiology (JACC), top AMA cardiology (JAMA Cardiology), or top global-impact (Lancet).

Reviewers at European Heart Journal typically draw from 2 cardiology subspecialty experts under a single-anonymized model. Editors screen and triage manuscripts before any reviewer sees them, and preparing a response template that addresses both cardiology-priority and statistical-adequacy perspectives accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the European Heart Journal cardiology-priority-plus-statistical-rigor bar before submission, our European Heart Journal pre-submission diagnostic flags the framing and statistical weaknesses most likely to surface in reviewer reports.