Impact of Routine Electrocardiogram Testing in Adult Health Screening on New Outpatient Visit Rates and Cardiovascular Disease Mortality

Figures

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  Figure 1.. Examining the relationship between health screening ECG implementation rates and outpatient visits/disease mortality rates. Based on prior literature, we selected the top 5 prefectures in Japan (defined as the “Full group”, shown in blue) with nearly 100% health screening ECG implementation rates and the bottom 5 prefectures (defined as the “Poor group”, shown in red) with 0% implementation rates. From Japan’s open databases, we extracted statistical indicators: estimated outpatient and inpatient patient numbers by disease (particularly cardiovascular diseases, based on the Ministry of Health, Labour and Welfare’s triennial patient surveys) and disease-specific mortality rates (based on Japan’s annual vital statistics). We statistically compared these recent indicators between the Full and Poor groups to verify whether ECG screening itself contributes to health outcomes (as a research design feasible for an observational study).

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  Figure 2.. Number of new outpatient visits for cardiovascular disease by region based on ECG screening implementation rate. Estimated patient numbers by disease were calculated based on the patient survey conducted every 3 years by Japan’s Ministry of Health, Labour and Welfare. For both groups, the number of new outpatient visits for cardiovascular disease (population-adjusted) in 2017 was set as 1, showing relative values over time. In the Full group, where ECG implementation rates in adult health screening were nearly 100%, the number of new outpatient visits for cardiac disease, ischemic heart disease, and cerebrovascular disease tended to be relatively higher compared to the Poor group, where ECG implementation rates were 0%. A statistically significant difference was observed for cerebral infarction specifically by 2023 (P=0.04) (n=5, per group). *P<0.05. All values are mean±SEM.

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  Figure 3.. Annual trends in cardiovascular disease mortality rates across regions based on ECG screening rates. Disease-specific mortality rates by prefecture are verified based on demographic statistics conducted annually by Japan’s Ministry of Health, Labour and Welfare. Both groups set the 2019 cardiovascular disease-specific mortality rate (population-adjusted) as 1, showing relative values over time. In the Full group, where ECG implementation rates in adult health screening were nearly 100%, mortality rates for cerebrovascular disease tended to be lower overall compared to the Poor group without ECG screening, showing a statistically significant difference by 2024 (P=0.03). No significant difference was observed for mortality rates related to cardiac disease (n=5, per group). *P<0.05. All values are mean±SEM.