Peter Libby, Robert O. Bonow, Douglas L. Mann, Gordon F. Tomaselli, Deepak L. Bhatt, Scott D. Solomon, and Eugene Braunwald

The knowledge relevant to the practice of cardiology continues to grow by leaps and bounds. Scientific and clinical advances have occurred at such a rapid pace that clinicians often suffer information overload. Communications about advances in cardiovascular medicine inundate practitioners on a seemingly minute-to-minute basis through journals, mailings, text messages, newsletters, social media, webinars, advertisements, and other electronic and print media. How can a practitioner or trainee sift through this cacophony to discern reliable, durable, and important information critical for practice?

This textbook of cardiovascular medicine offers a solution to this quandary. The 12th edition of Braunwald’s Heart Disease provides a comprehensive, carefully curated, balanced, and unbiased distillation not only of the tried and true, but especially the latest advances in our field. This volume should serve the novice and experienced practitioner alike. Trainees and those preparing for certification or recertification examinations can use this text for an overall review of contemporary cardiovascular medicine. Practitioners confronting a particular clinical problem can consult the appropriate section of the book on an as-needed basis to answer the clinical question at hand to aid on- the- spot clinical decision making. While not a basic science textbook, this volume builds on Dr. Braunwald’s founding vision and reviews fundamental pathophysiologic mechanisms to furnish a foundation for informed practice where appropriate.

Cardiovascular medicine has expanded so enormously that few if any individuals can maintain mastery of the entire scope of practice. Sub-specialization and even sub-sub-specialization have increased. Yet, each of us encounters issues within these super-specialized areas when we care for and counsel our own patients. The palette of patients’ problems often overlaps the fine divisions our specialty has developed. This book aims to provide a ready reference so that we can update our knowledge with recent and authoritative information in areas of cardiovascular medicine afield from our own primary areas of expertise. The online content of this textbook contains additional new figures and tables, as well as over 200 videos that add to the printed version. Furthermore, through twice monthly online updates by Dr. Braunwald and through Elsevier’s ClinicalKey, this textbook undergoes constant updating. Indeed, with the addition of companion volumes, the Heart Disease family has become a living learning system and comprehensive reference.

As necessitated by evolution and progress in cardiovascular medicine, in planning this 12th edition the editors have carefully reviewed the content to reflect current knowledge. This edition has 14 totally new chapters. For example, we have added chapters on artificial intelligence in cardiology and on the use of wearables in cardiovascular medicine. These two topics will doubtless change our practices profoundly. We expect that future editions will continue to build on these and other novel areas that will provide us with innovative tools to con-front our patients’ problems.

We have added a new chapter, “Impact of the Environment on Cardio-vascular Health,” as we recognize increasingly the clinical importance of this critical interface. Another new chapter, “Cardiovascular Disease Risk of Nicotine and Tobacco Products,” highlights the concerning increase in smokeless tobacco use among youth. The burgeoning field of cardio-oncology has expanded coverage in the 12th edition, with two chapters devoted to different aspects of this topic. Expanded coverage of valvular heart disease includes a new chapter on interventions for mitral and tricuspid valvulopathies, which complements an updated chapter on percutaneous interventions for the aortic valve. These additions acknowledge the growing role of structural heart dis-ease interventions in tackling these conditions.

The period of planning and preparation of this 12th edition coincided with the pandemic caused by SARS-CoV-2. We would be remiss not to include an expanded discussion of viral heart diseases in a new chapter, as our specialty needs to prepare for likely future viral pandemics, as well as deal with the potentially long-term cardiovascular consequences of COVID-19. Of course, each and every chapter in the book has undergone extensive updating and revision to reflect advances since the last edition. To this end, a number of chapters are completely written de novo by new authors. Indeed, the 12th edition boasts almost 80 new authors, reflecting our commitment to continuous refreshment and review of the content.

Our field can take considerable pride in the rapid advances in both basic and clinical investigation that this book highlights. Yet, we face a disconnect between these advances and their application to practice. To this end we include a new chapter, “Impact of Health Care Policy on Quality and Outcomes of Cardiovascular Disease,” that focuses on practical societal approaches to ensure that our patients can benefit from the clinical and basic scientific advances in our field. Moreover, closing gaps in offering progress in cardiovascular medicine to racially, ethnically, geographically diverse, or underserved populations presents a global challenge. We focus on cardiovascular conditions in particular segments of the population—women, people with diabetes, and those with HIV/AIDS—that may require specialized approaches; each of these and others have been accorded a separate chapter. The global pandemic has placed disparities and inequities in health care in stark relief, locally and globally. To address this problem, a new chapter, “Heart Disease in Racially and Ethnically Diverse Populations,” deals with cardiovascular conditions that confront disadvantaged segments of our population.

Finally, the Editors were fortunate to enlist Professor Eugene Braunwald, the founder of this textbook, to contribute an opening chapter, “Cardiovascular Disease: Past, Present, and Future,” which shares his vision from his uniquely broad perspective. We have striven to uphold the standards that he set for this textbook from the first five editions that he edited solo. We have aimed to emulate his editorial prowess and example of refreshing every page of this textbook in each edition to maximize its utility for all who care for patients with or at risk of developing cardiovascular disease.

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