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.
Circulation reports · 2026-06-26 · Registry study
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.