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
- 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.
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