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

  1. Luisa Campos Caldeira Brant
  2. Bruno Ramos Nascimento
  3. Renato Azeredo Teixeira
  4. Marcelo Antônio Cartaxo Queiroga Lopes
  5. Deborah Carvalho Malta
  6. Glaucia Maria Moraes Oliveira
  7. Antonio Luiz Pinho Ribeiro

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Abstract

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.

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  1. Version published to 10.1136/heartjnl-2020-317663
  2. ScreenIT

    SciScore for 10.1101/2020.06.24.20139295: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The search terms were grouped based on a standardized dictionary and treated based on the IRIS software12 and text mining methods were additionally applied to search for terms that identify the final diseases.
    IRIS
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Besides patient-based factors, reorganization of acute care systems, such as: deactivation of specific services to meet urgent needs of emergency or intensive care, delimitation of COVID-specific hospitals, and implementation of alternative therapeutic pathways; which aim to mitigate the effects of the pandemic, may further prevent patient presentation to medical care4-7. Thus, public campaigns must be warranted to raise awareness about the importance of cardiovascular care, even during this challenging period. Of note, the deleterious effects on cardiovascular events may last longer than the pandemic itself, as primary and secondary preventions are being delayed in this context27.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.24.20139295v1 on medRxiv