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

Abstract

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.

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“…Backlogs and capacity constraints will result in excess mortality attributable to COVID-19—already modelled for several disease areas such as cancer 14 15 and cardiovascular disease. 16 17 Catching up on backlogs will place additional, competing demands on the resources available. Investment in vaccination will need to account for this ‘suspended care need’ and should be weighed against the immediate and longer term requirements for the delivery of routine health programmes.…”

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“…5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home). 4 They also found that healthcare system collapse in more socioeconomically deprived states was associated with increased acute coronary syndrome and stroke deaths in these states, independent of the uptick in deaths at home.…”

“…Brant et al looked at cardiovascular mortality in six Brazilian capital cities. 4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals. 5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand: the restructuring of hospital services to cope with an influx of COVID-19 cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.…”

Vacinação do Cardiopata contra COVID-19: As Razões da Prioridade

“…Por outro lado, houve redução percentual das notificações de óbitos por síndrome coronariana aguda (SCA) e acidente vascular cerebral (AVC), com maior magnitude no Nordeste, seguindo-se as regiões Centro-Oeste e Sudeste (capital e interior). 3 …”

“…As diferenças regionais exprimem as desigualdades socioeconômicas e étnicas de um país continental, sendo ainda consequência de um sistema de saúde com recursos heterogêneos e mal distribuídos. 3 …”