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

StudyCirculation reports· Aug 2026

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.

Hiroki Sato, Naohiko Takahashi, Naohiro Yonemoto … Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group

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Resuscitation & Cardiac ArrestStudy

Higher regional 12-lead electrocardiography testing intensity associated with lower cardiac arrest incidence

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.

Hiroki Sato … Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group

Circulation reports · Aug 2026

Background

Cardiac-origin out-of-hospital cardiac arrest (cardiac-origin out-of-hospital cardiac arrest) remains a public health challenge, and variations in its incidence may reflect differences in cardiovascular care.

Purpose

We investigated whether the intensity of regional outpatient cardiovascular diagnostic testing was associated with the cardiac-origin out-of-hospital cardiac arrest incidence among adults aged 40-74 years in Japan.

Methods

This prefecture-level ecological study (2014-2023) used the All-Japan Utstein Registry and National Database Open Data.

n = 248,633 patients

Results

more electrocardiography testing regionally, fewer cardiac arrests

RR 0.95 (95% CI 0.93 to 0.98)

CI excludes the null - significant

More results

The outcome was the age- and sex-standardized incidence ratio (SIR) of cardiac-origin out-of-hospital cardiac arrest.

The intensity of outpatient 12-lead electrocardiography (electrocardiography) testing was quantified as an observed/expected ratio.

More results

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).

In this nationwide ecological study, higher prefecture-level 12-lead electrocardiography testing intensity was associated with lower cardiac-origin out-of-hospital cardiac arrest SIR among adults aged 40-74 years.

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Conclusion · 1 of 2

In this nationwide ecological study, higher prefecture-level 12-lead electrocardiography testing intensity was associated with lower cardiac-origin out-of-hospital cardiac arrest SIR among adults aged 40-74 years.

Conclusion · 2 of 2

Although causal interpretation is not possible, 12-lead electrocardiography testing intensity may represent a prefecture-level indicator of regional outpatient cardiovascular care and offer a useful perspective for understanding geographic variations in cardiac-origin out-of-hospital cardiac arrest burden.

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.

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.

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