ArticleCirculation reports2026
Regional Intensity of Outpatient Cardiovascular Testing and Cardiac-Origin Out-of-Hospital Cardiac Arrest: A 10-Year Nationwide Ecological Study Using the All-Japan Utstein Registry.
Article in Circulation reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cardiac-origin out-of-hospital cardiac arrest (CO-OHCA) remains a public health challenge, and variations in its incidence may reflect differences in cardiovascular care. We investigated whether the intensity of regional outpatient cardiovascular diagnostic testing was associated with the CO-OHCA incidence among adults aged 40-74 years in Japan. Methods and Results: This prefecture-level ecological study (2014-2023) used the All-Japan Utstein Registry and National Database Open Data. The outcome was the age- and sex-standardized incidence ratio (SIR) of CO-OHCA. The intensity of outpatient 12-lead electrocardiography (ECG) testing was quantified as an observed/expected ratio. Among 248,633 patients, higher 12-lead ECG testing intensity was significantly associated with lower SIR after adjusting for calendar year and cardiometabolic risk factors (rate ratio [RR] 0.95 per 0.1-unit increase; 95% confidence interval [CI] 0.93-0.98; P<0.001). Conversely, higher obesity prevalence was associated with higher SIR (RR 1.35 per 10-percentage-point increase; 95% CI 1.16-1.57; P<0.001). No significant associations were seen for transthoracic echocardiography and B-type natriuretic peptide/N-terminal pro B-type natriuretic peptide testing. Conclusions: In this nationwide ecological study, higher prefecture-level 12-lead ECG testing intensity was associated with lower CO-OHCA SIR among adults aged 40-74 years. Although causal interpretation is not possible, 12-lead ECG testing intensity may represent a prefecture-level indicator of regional outpatient cardiovascular care and offer a useful perspective for understanding geographic variations in CO-OHCA burden.
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