Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.2270 Dr. Ryuichiro Yagi et al.
Points
- A nationwide cohort study in Japan involving over 3.5 million adults aged 35 to 65 examined the significance of resting electrocardiogram (ECG) screenings for predicting cardiovascular disease (CVD) outcomes in a clinical setting, utilizing data from the Japan Health Insurance Association database.
- Baseline ECG findings were categorized into normal, one minor abnormality, two or more minor, and significant abnormalities. The primary outcomes measured were overall mortality and hospital admissions for major CVD events like myocardial infarction, stroke, and heart failure.
- Over a five-year median follow-up of 5.5 years, individuals with any baseline ECG abnormalities had higher incidence rates of severe outcomes than those with normal ECGs. Incidence rates per 10,000 person-years were 92.7 for normal ECG, 128.5 for one minor abnormality, 159.7 for two or more minor abnormalities, and 266.3 for significant abnormalities. Adjusted hazard ratios for these categories were 1.19, 1.37, and 1.96, respectively.
- Minor ECG abnormalities predicted the development of new significant ECG abnormalities. Adjusted hazard ratios were 2.52 for one minor abnormality and 3.61 for two or more minor abnormalities, highlighting a clear correlation between baseline minor ECG abnormalities and increased risk of more severe ECG changes.
- The study supports the potential utility of routine ECG screenings in the working-age population to identify high-risk individuals early and guide preventive healthcare strategies to mitigate the risk of serious cardiovascular events.
Summary
In a substantial nationwide cohort study involving over 3.5 million Japanese adults aged 35 to 65, researchers examined the prognostic significance of resting electrocardiogram (ECG) screenings for cardiovascular disease (CVD) in a clinical practice. This study, which utilized data from the Japan Health Insurance Association database covering approximately 40% of Japan’s working-age population, spanned from April 1, 2015, to March 31, 2022. The primary focus was to explore the association between baseline ECG abnormalities and subsequent cardiovascular outcomes, analyzing data up to April 11, 2024.
The study categorized baseline ECG findings into normal, one minor abnormality, and two or more minor and significant abnormalities. The primary outcomes measured were overall mortality and hospital admissions for major CVD events such as myocardial infarction, stroke, and heart failure. Over a five-year median follow-up of 5.5 years, findings revealed that individuals with any ECG abnormalities at baseline had higher incidence rates of these severe outcomes than those with a normal ECG. Specifically, incidence rates per 10,000 person-years were 92.7 for normal ECG, 128.5 for one minor abnormality, 159.7 for two or more minor abnormalities, and 266.3 for significant abnormalities. Correspondingly, adjusted hazard ratios for these categories were 1.19, 1.37, and 1.96, indicating a progressively higher risk with the severity of the initial ECG findings.
Furthermore, the study demonstrated that minor ECG abnormalities were predictive of the development of new significant ECG abnormalities. Adjusted hazard ratios were 2.52 for one minor abnormality and 3.61 for two or more minor abnormalities. This underscores a clear correlation between baseline minor ECG abnormalities and an increased risk of developing more severe ECG changes. These results support the potential utility of routine ECG screenings in the working-age population to identify high-risk individuals early and potentially guide preventive healthcare strategies to mitigate the risk of serious cardiovascular events.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721
References Yagi, R., Mori, Y., Goto, S., Iwami, T., & Inoue, K. (2024). Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adults. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.2270
