Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Heart. 2020 Dec;106(24):1898-1905. doi: 10.1136/heartjnl-2020-317663. Epub 2020 Oct 15.
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.
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.
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).
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.
在 COVID-19 大流行期间，已报告超额死亡率，而急性心血管事件的住院率下降。巴西是 COVID-19 死亡人数第二多的国家。我们旨在评估 COVID-19 大流行期间巴西 6 个首府城市的心血管超额死亡率。
我们使用民事登记公共数据库，评估了 6 个拥有更多 COVID-19 死亡人数的巴西城市（圣保罗、里约热内卢、福塔雷萨、累西腓、贝伦、马瑙斯）的总心血管超额死亡和心血管特定死亡（急性冠状动脉综合征和中风）和非特定心血管死亡。我们将观察到的死亡人数与 2020 年第 12-22 周的预期死亡人数进行比较。我们还比较了该期间的医院和家庭死亡人数。
在所研究的期间和城市中，2020 年有 65449 人死亡和 17877 人死于 COVID-19。大多数城市的心血管死亡率增加，北部首府的增幅更大。然而，虽然大多数城市的特定心血管死亡人数有所减少，但北部首府的这些事件有所增加。对于非特定心血管死亡，所有城市都有明显增加，这与家庭死亡人数的增加密切相关（r=0.86，p=0.01）。
欠发达城市的心血管超额死亡率更高，可能与医疗保健系统崩溃有关。最发达城市的特定心血管死亡人数下降，同时非特定心血管和家庭死亡人数增加，可能是误诊的结果。相反，医疗保健系统崩溃的城市的特定心血管死亡人数增加。
