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Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities
  1. Luisa Campos Caldeira Brant1,2,
  2. Bruno Ramos Nascimento1,2,
  3. Renato Azeredo Teixeira3,
  4. Marcelo Antônio Cartaxo Queiroga Lopes4,5,
  5. Deborah Carvalho Malta6,
  6. Glaucia Maria Moraes Oliveira7,
  7. Antonio Luiz Pinho Ribeiro1,2
  1. 1 Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2 Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  3. 3 Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  4. 4 Sociedade Brasileira de Cardiologia, Rio de Janeiro, Rio de Janeiro, Brazil
  5. 5 Cardiologia Intervencionista, Hospital Alberto Urquiza Wanderley, João Pessoa, Paraíba, Brazil
  6. 6 Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  7. 7 Faculdade de Medicina e Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  1. Correspondence to Professor Antonio Luiz Pinho Ribeiro, Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; tom1963br{at}


Introduction During the COVID-19 pandemic, excess mortality has been reported, while hospitalisations for acute cardiovascular events reduced. Brazil is the second country with more deaths due to COVID-19. We aimed to evaluate excess cardiovascular mortality during COVID-19 pandemic in 6 Brazilian capital cities.

Methods Using the Civil Registry public database, we evaluated total and cardiovascular excess deaths, further stratified in specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular deaths in the 6 Brazilian cities with greater number of COVID-19 deaths (São Paulo, Rio de Janeiro, Fortaleza, Recife, Belém, Manaus). We compared observed with expected deaths from epidemiological weeks 12–22 of 2020. We also compared the number of hospital and home deaths during the period.

Results There were 65 449 deaths and 17 877 COVID-19 deaths in the studied period and cities for 2020. Cardiovascular mortality increased in most cities, with greater magnitude in the Northern capitals. However, while there was a reduction in specified cardiovascular deaths in the most cities, the Northern capitals showed an increase of these events. For unspecified cardiovascular deaths, there was a marked increase in all cities, which strongly correlated to the rise in home deaths (r=0.86, p=0.01).

Conclusion Excess cardiovascular mortality was greater in the less developed cities, possibly associated with healthcare collapse. Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse.

  • acute coronary syndromes
  • health care delivery
  • stroke
  • coronary artery disease

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  • GMMO and ALPR contributed equally.

  • Contributors Conception and design of the research: MAQL, GMMO, ALPR, LCCB, BRN. Acquisition of data: ALPR, MAQL, GMMO and DCM. Analysis and interpretation of data: LCCB, BRN, RAT, GMMO, DCM, ALPR. Statistical analysis: RAT. Obtaining financing: N/A. Writing of the manuscript: LCCB, BRN. Critical revision of the manuscript for intellectual content: all authors. Authors responsible for the overall content as guarantors: LCB, BN, TR.

  • Funding ALPR was supported in part by CNPq (Bolsa de produtividade em pesquisa, 310679/2016–8) and by FAPEMIG (Programa Pesquisador Mineiro, PPM-00 428-17). BRN was supported in part by CNPq (Bolsa de produtividade em pesquisa, 312382/2019-7), and by the Edwards Lifesciences Foundation (Every Heartbeat Matters Program 2020); DCM was supported in part by CNPq (Bolsa de produtividade em pesquisa, 308250/2017–6), and by FAPEMIG (Programa Pesquisador Mineiro).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Universidade Federal de Minas Gerais Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data analytic methods and study materials will be made available to other researchers for purposes of reproducing the results or replicating the procedure, from the corresponding author on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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