Cardiovascular Mortality During the COVID-19 Pandemics in a Large Brazilian City: A Comprehensive Analysis

Abstract

Introduction:The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality.Objective: To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the sixth greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemic's phase.Methods: Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD-10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10-48, 2020, were compared to the expected rates (mean of 2015-2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated for all estimates. Population projected to 2020 for BH and its census tracts were used to calculate rates. Results:We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96-1.06). However, CVD deaths occurred more at homes (RiR 1.32, than in hospitals (RiR 0.89, 95%CI 0.79-0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21). Conclusion:The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH. 2 Brant et al.

Geospatial analysis of cardiovascular mortality before and during the COVID-19 pandemic in Peru: analysis of the national death registry to support emergency management in Peru

“…Primarily, a significant increase in total deaths due to CVD was observed during the pandemic period, with 19,376 deaths recorded compared to 8,821 deaths in the pre-pandemic period. Previous reports ( 6 , 23 – 29 ) support our findings and indicate that CVD is a primary mortality factor in COVID-19 patients. These outcomes imply an association between the pandemic and increased CVD-related deaths, potentially attributed to factors such as limited access to medical care ( 6 ), treatment postponements ( 7 ), pre-existing CVD ( 8 , 26 ), and the impact of pandemic-related stress.…”

“…However, it is essential to note that CVD rates within hospitalizations exhibited a relative decrease, suggesting a considerable number of deaths occurred outside of hospitals, such as in homes or clinics ( 24 ). For instance, in socially vulnerable cities like Belo Horizonte in Brazil, higher rates of non-hospital deaths were observed ( 29 ). This phenomenon can be attributed to significant shifts in healthcare delivery induced by the COVID-19 pandemic.…”

Estatística Cardiovascular – Brasil 2023

“…IC 95%, 0,75-0,84) e mortes hospitalares (RR 0,76; IC 95%, 0,57-1,01) por SCA, além de aumento nos óbitos domiciliares (RR 1,38; IC 95%, 1,04-1,82) 66. • Em estudo de série temporal em Belo Horizonte, o número de hospitalizações por SCA no período pandêmico de 2020 foi 21% menor do que o projetado (n=2.369 e 3.013, respectivamente).142• As admissões por eventos coronarianos urgentes e eletivos entre 18 de março e 30 de setembro de 2020 foram comparadas às hospitalizações durante uma série histórica de dois anos (2018 e 2019) no contexto do plano de saúde UNIMED-BH, um sistema médico privado que cobre aproximadamente 1,31 milhão de indivíduos (22% da população) na área metropolitana de Belo Horizonte.…”

A Pandemia de COVID-19 e a Doença Cardiovascular no Brasil: Aprendendo com os Dados

“…[4][5][6][7][8][9][10] Importantly, a repeatedly reported finding is an uncomfortable increase in home deaths. [11][12][13] Therefore, it is now clear that the pandemic has substantially impacted CVD care in Brazil.…”

“…15 Also, Brant et al reported that the increase in CVD home deaths in Belo Horizonte-MG in 2020 was more pronounced in more socially vulnerable individuals. 13 Identifying the most affected subgroups is strategic for defining priority targets for public health interventions and avoiding the dangerous path of increasing health inequalities.…”