Impact of abnormal findings in health check-ups on medical care: findings from 15 years of health check-ups

Background Health check-ups are routinely conducted in Japan for the early detection and initiation of treatment for diseases. These check-ups typically include resting electrocardiograms (ECG), blood pressure (BP) measurements, glucose metabolism tests, and lipid metabolism tests. However, evidence regarding the effectiveness of these screenings in improving medical care in the general population remains limited. Purpose This study aimed to evaluate the efficacy of ECG, BP, glucose metabolism, and lipid metabolism screenings by assessing their positive predictive value, specifically the proportion of individuals identified as needing medical care based on abnormal findings during routine health check-ups. Methods This cohort study included individuals aged ≥18 years who underwent health check-ups at our institute between April 1, 2008, and March 31, 2023. We first evaluated the rate of recommendations for medical consultation prompted by abnormal findings in ECG, BP, glucose metabolism, or lipid metabolism and patient history obtained during health-checkups. The primary outcome was the decision of healthcare providers to initiate medical care, including intervention or follow-up, after those consultations. Results A total of 110,807 health check-up data, including those of repeat examinee, were analyzed (mean [SD] age, 53.6 [10.1] years; 56.2% male). Of these, 1,899 (1.7%) were referred for further medical evaluation due to ECG abnormalities, 4,522 (4.1%) due to BP abnormalities, 3,001 (2.7%) due to glucose metabolism abnormalities, and 11,299 (11.1%) due to lipid metabolism abnormalities. Follow-up data were subsequently obtained from consulting physicians for 1,129 (59.5%) of those with ECG abnormalities, 1,687 (37.3%) of those with BP abnormalities, 1,316 (43.9%) of those with glucose metabolism abnormalities, and 4,100 (33.3%) of those with lipid metabolism abnormalities (Figure 1). Cases with follow-up data were older, included more females and non-smokers, had more medical histories, more regular exercise habits, and healthier eating habits than those without follow-up data. The proportion requiring medical care among these cases with follow-up data was 53.0% (598/1,129) for those with ECG abnormalities, 84.8% (1,431/1,687) for those with BP abnormalities, 88.4% (1,163/1,316) for those with glucose metabolism abnormalities, and 88.3% (3,622/4,100) for those with lipid metabolism abnormalities (Figure 2). These proportions differed significantly depending on the examination (chi-square test, P < 0.001). Conclusions These findings indicate that health check-up recommendations based on abnormal ECG, BP, or glucose/lipid metabolism findings during health check-ups effectively identify individuals requiring medical care. Further research should aim to refine ECG screening methods, and optimize follow-up strategies for BP, glucose metabolism, and lipid metabolism abnormalities.