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Regional Intensity of Outpatient Cardiovascular Testing and Cardiac-Origin Out-of-Hospital Cardiac Arrest: A 10-Year

Hiroki Sato1,2, Naohiko Takahashi1, Naohiro Yonemoto3

  • 1Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University Oita Japan.

Circulation Reports
|August 11, 2026
PubMed

Insights

Higher outpatient 12-lead electrocardiography (ECG) testing intensity was linked to fewer cardiac-origin out-of-hospital cardiac arrests (CO-OHCA). This suggests ECG testing intensity may reflect regional cardiovascular care quality.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Cardiac-origin out-of-hospital cardiac arrest (CO-OHCA) is a significant public health concern.
  • Geographic variations in CO-OHCA incidence may indicate disparities in cardiovascular care.
  • Understanding factors influencing CO-OHCA rates is crucial for public health strategies.

Purpose of the Study:

  • To investigate the association between regional outpatient cardiovascular diagnostic testing intensity and CO-OHCA incidence in Japan.
  • To explore the relationship between 12-lead electrocardiography (ECG) testing intensity and CO-OHCA rates in adults aged 40-74.
  • To determine if other diagnostic tests, like echocardiography, are similarly associated with CO-OHCA incidence.

Main Methods:

  • A prefecture-level ecological study was conducted using data from 2014-2023.
  • Data sources included the All-Japan Utstein Registry and National Database Open Data.
  • The primary outcome was the age- and sex-standardized incidence ratio (SIR) of CO-OHCA, with 12-lead ECG testing intensity quantified as an observed/expected ratio.

Main Results:

  • Higher 12-lead ECG testing intensity was significantly associated with a lower CO-OHCA SIR (rate ratio 0.95 per 0.1-unit increase; P<0.001).
  • Increased obesity prevalence was associated with a higher CO-OHCA SIR (rate ratio 1.35 per 10-percentage-point increase; P<0.001).
  • No significant associations were found for transthoracic echocardiography or B-type natriuretic peptide testing intensity.

Conclusions:

  • Higher prefecture-level 12-lead ECG testing intensity correlated with lower CO-OHCA SIR in adults aged 40-74.
  • While causality cannot be inferred, 12-lead ECG testing intensity may serve as an indicator of regional outpatient cardiovascular care.
  • This finding offers a valuable perspective for understanding geographic disparities in the CO-OHCA burden.
Abstract

Keywords:
All-Japan Utstein RegistryElectrocardiogramObesityOut-of-hospital cardiac arrest

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