Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities

• Published in: Heart (British Cardiac Society) Vol. 106; no. 24; pp. 1898 - 1905
• Main Authors: Brant, Luisa Campos Caldeira, Nascimento, Bruno Ramos, Teixeira, Renato Azeredo, Lopes, Marcelo Antônio Cartaxo Queiroga, Malta, Deborah Carvalho, Oliveira, Glaucia Maria Moraes, Ribeiro, Antonio Luiz Pinho
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.12.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Acute coronary syndromes; Brazil - epidemiology; Cardiac arrhythmia; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Cause of Death; Cities; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - mortality; COVID-19 diagnostic tests; Databases, Factual; Dictionaries; Disease; Health care; Healthcare Delivery, Economics and Global Health; Hospital Mortality; Hospitals; Human Development Index; Humans; Intensive care; Mortality; Pandemics; Pneumonia; Registries; Retrospective Studies; Sepsis; Stroke; Time Factors; Urban Health - trends; Brazil; Italy; Rio de Janeiro Brazil; coronary artery disease; health care delivery; stroke; acute coronary syndromes
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2020-317663

IntroductionDuring 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.MethodsUsing 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.ResultsThere 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).ConclusionExcess 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.