Early detection of atrial fibrillation (AF) is essential for preventing ischemic stroke and other cardiovascular complications. However, the incidence and prognosis of AF in the general middle-aged population remain unclear. In Japan, annual health screenings for employees include mandatory ECGs, offering a unique opportunity to fill this evidence gap. This retrospective cohort study aimed to evaluate the incidence and subsequent cardiovascular outcomes of screening-detected AF in the general working population in Japan, using the Japan Health Insurance Association database, which covers one-quarter of the working-age population of that country. From individuals 35 to 59 years of age who underwent annual health screenings between April 2015 and March 2020, excluding those with a history of cardiovascular disease, those with initial AF detection upon screening ECGs were identified. The primary outcome was hospitalization for ischemic stroke. The secondary outcomes were all-cause death and hospitalization for heart failure. The association between screening-detected AF and outcomes was evaluated using adjusted subdistribution hazard models compared with matched controls.

Findings: Among 9.5 million individuals included in our study, 11,790 initial AF cases  were detected. Individuals with AF were older and more likely to be male compared with non-AF cases (91.6% versus 63.6%, respectively). Among these individuals with screening-detected AF, the 3-year incidences of ischemic stroke, all-cause death, and heart failure were 1.83% , 0.78%, and 3.87%, respectively. Compared with age- and sex-matched controls, individuals with AF had a higher risk of incident ischemic stroke, all-cause death, and heart failure.

These findings highlight the association of screening-detected AF with stroke and heart failure, warranting further study into AF as an early sign of heart failure and optimal cardiovascular risk reduction strategies after AF detection in the general middle-aged population.
 

Authors investigate whether the association between diabetes and suicide risk varies by area-level deprivation. They conducted a matched-pair cohort study using a nationwide health insurance database in Japan. Individuals with diabetes were matched 1:1 with those without diabetes by age, sex, and insurance status (i.e., insured person or their dependents). Area-level deprivation was assessed with a census-based Areal Deprivation Index (ADI). A Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of suicide for individuals with diabetes by area-level deprivation level.

Findings: Among 5,31 million individuals (54.8% men, mean age 52.9 years), we observed 760 suicides. Individuals with diabetes experienced a higher risk of suicide than those without diabetes. The association between diabetes and suicide was stronger in less deprived areas than more deprived areas. Findings suggest greater psychosocial challenges of diabetes diagnosis and management faced by individuals living in less deprived areas, or a possibility that diabetes diagnosis may reduce disparities by improving healthcare access in more deprived areas.

To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan. This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Authors analyzed the rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

Findings: Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients more than those in Eastern Japan.

Between August 2020 and April 2024, U.S. hospitals were mandated to report weekly occupancy to the Department of Health and Human Services as part of COVID-19 data tracking efforts. Authors repurposed this COVID-19 dashboard to describe several possible U.S. hospital bed occupancy scenarios arising from an aging U.S. population over the next decade, while varying hospitalization rates and staffed hospital bed supply.

Findings: The mean U.S. hospital occupancy was 63.9% from 2009 to 2019 compared with 75.3% in the year following the end of the COVID-19 public health emergency (PHE). The number of staffed hospital beds declined from a prepandemic steady state of 802,000 (2009–2019 mean) to a post-PHE steady state of 674,000, whereas the mean daily census steady state remained at approximately 510,000. There was substantial state-to-state variation in the post-PHE hospital occupancy steady state.

Without changes in the hospitalization rate or staffed hospital bed supply, total annual hospitalizations were projected to increase from 36,174,000 in 2025 to 40,177,000 in 2035 with the aging population. This would correspond to a national hospital occupancy of approximately 85% by 2032 for adult beds and by 2035 for adult and pediatric beds combined.

Experts in developed countries have posited that a national hospital occupancy of 85% constitutes a hospital bed shortage (a conservative estimate). The findings show that the U.S. could reach this dangerous threshold as soon as 2032, with some states at much higher risk than others. These scenarios suggest that an increase in the staffed hospital bed supply by 10%, reduction in the hospitalization rate by 10%, or some combination of the two would offset the aging-associated increase in hospitalizations over the next decade.