JACC Under Review: What the Status Means

The first status period is not the full scientific review. It is the journal checking whether the record can be handled: files open correctly, author metadata is complete, disclosures are included, ethics statements are present, and the manuscript appears to match the journal's scope. For JACC, this stage matters because a small administrative issue can look like a peer-review delay from the author's side. If the status changes quickly to Under Review, read that as a routing signal, not as proof that every reviewer has accepted.

The useful action during this stage is not to ask whether the editor likes the paper. It is to make sure every status email, submission-form field, and manuscript file points to the same claim. A mismatch between the cover letter, abstract, figure sequence, methods, data, or supplementary files creates editorial friction even when the work is credible. For JACC, the file package should make clear that the manuscript is about JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement rather than a generic manuscript looking for a prestigious home before a reviewer has to reconstruct the claim.

At this point the manuscript is being read for fit. The editor is not only asking whether the manuscript is polished, but whether the manuscript makes broad cardiovascular relevance, clinical consequence, priority for flagship JACC, Associate Editor fit, statistical stability, relationship-with-industry clarity, and routing against JACC specialty titles, Circulation, European Heart Journal, JAMA Cardiology, and disease-specific cardiology journals visible quickly enough to justify outside review. A manuscript can be technically careful and still difficult to route if the abstract promises one contribution while the methods, figures, data, or supplementary files support another.

The editor may be matching the manuscript to cardiology subspecialty reviewers, clinical-trials reviewers, cardiovascular imaging reviewers, interventional or heart-failure reviewers, biostatisticians, JACC Associate Editors, and conflict-screened external reviewers. That matching process can take time because the editor needs reviewers who can evaluate the central claim without rebuilding the manuscript's logic from scratch. Under Review can therefore cover both reviewer recruitment and active review.

At JACC, the handling editor is usually testing broad cardiovascular relevance, clinical consequence, priority for flagship JACC, Associate Editor fit, statistical stability, relationship-with-industry clarity, and routing against JACC specialty titles, Circulation, European Heart Journal, JAMA Cardiology, and disease-specific cardiology journals. The portal can show Under Review while the handling editor checks JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement. That editorial culture matters because a strong manuscript can still fail if the review path makes it look like the wrong article type, audience, or venue. A JACC handling editor is also deciding whether the paper should stay in this exact journal lane or route to JACC specialty titles, Circulation, European Heart Journal, JAMA Cardiology, American Heart Journal, Heart, Cardiovascular Research, and disease-specific cardiology journals before the full reviewer pool is assembled.

In parallel, the editor may be identifying two to three reviewers and checking whether the manuscript has the right scope for those reviewers. Recruiting reviewers can take 7 to 28 days when the topic sits between fields, depends on a specialized dataset, or requires both methodological and domain expertise. A JACC manuscript can therefore show Under Review while the editor is still securing the right reviewer mix.

For authors, the useful question is not "has someone accepted yet?" The useful question is "if a reviewer accepts today, would the manuscript's JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement make the claim easy to evaluate?" That is the difference between passive waiting and productive waiting.

This is the main period in which reviewers evaluate the paper. They are usually checking whether the conclusion follows from the methods, whether the strongest comparison or control is present, whether figures match claims, and whether limitations are honest. In JACC, the common weak point is not always the headline finding. It is often the missing bridge between the manuscript's strongest claim and the evidence a reviewer can audit quickly.

Active review is also where timeline anxiety becomes least informative. A quiet portal does not tell you whether one reviewer is late, whether the editor is waiting for another report, whether a reviewer declined and had to be replaced, or whether reports are already in synthesis. Days 14 to 70 is a practical JACC review and editor-synthesis window because the journal publicly describes a fast front-end process but still needs Associate Editor routing and reviewer reports for full review.

Use the waiting window to produce a revision-ready response map. Put the likely objection in one column, the manuscript location in another, the strongest supporting figure or table in a third, and the limitation language in a fourth. If the decision is revise, that map saves days. If the decision is reject, it helps you choose a cleaner transfer or resubmission path.

After reports arrive, the editor has to turn them into a decision. This can still look like Under Review, Reviews Complete, Required Reviews Complete, Awaiting Recommendation, or Decision in Process depending on the portal. Do not assume silence during this period means rejection. It can mean the editor is reconciling mixed reports, checking whether one reviewer misunderstood the scope, or deciding whether the manuscript needs another opinion.

The synthesis window is where the editor tests whether reviewer concerns are compatible. If one reviewer wants deeper methods and another wants a shorter argument, the decision letter may take longer because the editor has to decide which instruction governs the revision. That delay is procedural, not necessarily negative.

Not automatically. The most common explanation is reviewer recruitment or a delayed report, not a hidden rejection. The more useful interpretation is whether the elapsed time matches the stage. If the paper moved to Under Review quickly and then stayed there, the editor may still be waiting on one reviewer. If the status changed after several weeks, the editor may be synthesizing reports. If there has been no movement past the normal threshold, a polite inquiry is reasonable.

What you should not do is rewrite the manuscript in panic or submit elsewhere. Prepare the response materials that will matter if the decision is revise, reject with comments, or transfer.

Across our pre-submission reviews for JACC manuscript packages, three named patterns explain most of the productive work authors can do while the portal still says Under Review. These patterns are useful because they are tied to manuscript components a reviewer can inspect, not to generic advice about waiting.

Our review of JACC manuscript packages turns each status-risk pattern below into a concrete waiting-window task: inspect the abstract, first figure or model, methods, cover letter, data files, reporting notes, and limitation language before the reviewer report arrives.

The pages that create the most avoidable status anxiety are not always the obviously weak papers. They are credible papers where authors wait passively during Under Review instead of preparing for the exact review objections most likely to arrive. Official guidance explains the workflow, but it rarely connects the status label to the manuscript components reviewers will test.

• JACC cardiovascular data without broad clinical consequence: the study is cardiovascular, but the first figure, abstract, and conclusion do not yet show what changes for a broad cardiology audience. During Under Review, prepare a clinical-consequence map linking the primary endpoint, central illustration, perspectives box, and limitations. For JACC, connect this risk to JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement and to the exact reviewer audience the editor is likely to recruit.

• JACC specialty-lane paper aimed at the flagship: the manuscript may be strong for electrophysiology, imaging, heart failure, intervention, prevention, or cardio-oncology, but the broad JACC reader is not yet obvious. Build an answer explaining why this is flagship JACC rather than a JACC specialty title or disease-specific journal. For JACC, connect this risk to JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement and to the exact reviewer audience the editor is likely to recruit.

• JACC disclosure or endpoint fragility: relationship-with-industry detail, endpoint definitions, subgroup hierarchy, or statistical assumptions are not visible enough. Use the waiting window to align the title page, disclosure forms, methods, supplement, figures, and response blocks before reviewers press those issues. For JACC, connect this risk to JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement and to the exact reviewer audience the editor is likely to recruit.

• JACC reviewer-routing risk: The wrong reviewer pool can make a sound paper look less convincing than it is. Use the waiting window to identify how the abstract, keywords, suggested reviewers, article type, and field framing point to cardiology subspecialty reviewers, clinical-trials reviewers, cardiovascular imaging reviewers, interventional or heart-failure reviewers, biostatisticians, JACC Associate Editors, and conflict-screened external reviewers.

• JACC revision-readiness gap: Revision speed depends on whether authors already know which objection is likely. Draft answer blocks for the two most likely reviewer concerns before the decision letter arrives.

The recurring Manusights pattern is that authors often over-prepare the wrong asset while the manuscript is under review. They polish prose when the likely reviewer objection is a missing control, rewrite the introduction when the likely problem is a benchmark table, or wait for the decision letter when the abstract, methods, figures, theory, and supplementary files already reveal the response strategy. For JACC, the highest-value waiting work is to make the evidence chain explicit enough that a reviewer can test the claim without inventing the authors' logic.

Of the 100 most recent Manusights pre-submission reviews we use as a status-page pattern sample, the useful signal was not the portal label by itself. It was whether the draft already had a journal-specific evidence map before reports arrived. Official guidance explains the workflow, but that is why this page ties Under Review to JACC submission intake, author attestations, title page, structured abstract, central illustration or visual summary where required, perspectives box, relationship-with-industry disclosure, ICMJE forms, endpoint definitions, statistics, figures, tables, and clinical relevance statement instead of only defining the status phrase.

If you want a second set of eyes before the report lands, use the JACC AI review to identify reviewer-risk issues while the manuscript is still under review.

JACC specialty titles, Circulation, European Heart Journal, JAMA Cardiology, American Heart Journal, Heart, Cardiovascular Research, and disease-specific cardiology journals can be cleaner routes when the result needs more length, narrower readership, a different article format, or a different editorial promise. Do not treat transfer planning as pessimism. It is a way to shorten the next move if the decision letter confirms the current venue is one level too broad, too narrow, or too format-specific.

Official pages explain submission mechanics, but they usually do not translate a static Under Review label into the author's next practical move. Publisher resources identify the submission route, journal scope, and author-facing requirements; the Manusights layer interprets the status through JACC manuscript risk. The reader job is narrow: "my manuscript is already in the portal; what does this status mean and what should I do while waiting?"

The Manusights review link appears only after the status definition, timeline, follow-up threshold, source limitations, and journal-specific reviewer-risk prep. That keeps this status page focused on the waiting author while leaving the public submission guide to own pre-upload mechanics.

Source limitations: this page uses public official-source guidance plus Manusights manuscript-risk interpretation; it cannot see the private reviewer invitations, report status, or handling-editor notes inside your manuscript record.

Public journal guidance can tell you the portal, article-scope language, submission route, and broad peer-review policy. It usually cannot tell you whether your specific paper has reviewers assigned, whether a reviewer has missed a deadline, or whether the editor is leaning toward revision or rejection. That is why this page separates official-source facts from practical interpretation. The official sources anchor the workflow; the Manusights contribution is the manuscript-level risk translation.

Official sources used for this Under Review interpretation:

• https://www.jacc.org/journal/jacc/author-instructions
• https://www.jacc.org/doi/full/10.1016/S0735-1097%2819%2938637-1
• https://www.jacc.org/doi/10.1016/S0735-1097%2817%2939694-8
• https://www.jaccsubmit.org
• https://www.elsevier.com/trackarticle

Source-specific notes from this research pass:

• The official publisher pages identify the journal scope, submission route, and author-facing requirements for this status interpretation.
• The official portal or author-instruction page is the source of truth for the manuscript record; this page does not replace private portal status.
• The Manusights layer is the manuscript-risk translation: what to prepare while the status remains static.

• JACC hub
• JACC submission guide
• JACC review time
• Circulation Under Review
• European Heart Journal Under Review

Before you wait another month, run a JACC reviewer-risk check and prepare the revision map reviewers are most likely to force you to build later.