Sobre estas estatísticas Esta é a edição de 2021 da Estatística Cardiovascular – Brasil , um esforço multi-institucional para fornecer periodicamente informação atualizada sobre a epidemiologia das DCV e AVC no Brasil. Este relatório incorpora estatísticas oficiais fornecidas pelo Ministério da Saúde brasileiro e outros órgãos governamentais, pelo projeto GBD liderado pelo IHME da Universidade de Washington, além de dados gerados por outras fontes e estudos científicos, como coortes e registros, sobre as DCV e seus fatores de risco. Este [...] Sobre estas estatísticas Esta é a edição de 2021 da Estatística Cardiovascular – Brasil , um esforço multi-institucional para fornecer periodicamente informação atualizada sobre a epidemiologia das DCV e AVC no Brasil. Este relatório incorpora estatísticas oficiais fornecidas pelo Ministério da Saúde brasileiro e outros órgãos governamentais, pelo projeto GBD liderado pelo IHME da Universidade de Washington, além de dados gerados por outras fontes e estudos científicos, como coortes e registros, sobre as DCV e seus fatores de risco. Este

About these Statistics Brazil is a continental country of extreme diversity regarding climate and environmental conditions, population density, economic development, and racial and cultural features. One of the 10 richest economies of the world, it is also one of the most unequal countries: according to the World Bank, Brazil ranks among the 10 countries with the highest Gini index, a measurement of inequality in income distribution ( ). Brazil has one of the largest public health systems with universal coverage, [...] About these Statistics Brazil is a continental country of extreme diversity regarding climate and environmental conditions, population density, economic development, and racial and cultural features. One of the 10 richest economies of the world, it is also one of the most unequal countries: according to the World Bank, Brazil ranks among the 10 countries with the highest Gini index, a measurement of inequality in income distribution ( ). Brazil has one of the largest public health systems with universal coverage,

SOBRE ESTE DOCUMENTO A publicação Estatística Cardiovascular – Brasil tem por objetivo fornecer uma compilação anual dos dados e das pesquisas sobre a epidemiologia das DCV no Brasil. Este documento congrega as estatísticas oficiais do Ministério da Saúde do Brasil e outras entidades governamentais ao lado de dados do projeto GBD, coordenado pelo IHME da Universidade de Washington. Além disso, incorpora dados derivados de várias fontes e estudos científicos, inclusive coortes e registros, relacionados às DCV e fatores de risco [...] SOBRE ESTE DOCUMENTO A publicação Estatística Cardiovascular – Brasil tem por objetivo fornecer uma compilação anual dos dados e das pesquisas sobre a epidemiologia das DCV no Brasil. Este documento congrega as estatísticas oficiais do Ministério da Saúde do Brasil e outras entidades governamentais ao lado de dados do projeto GBD, coordenado pelo IHME da Universidade de Washington. Além disso, incorpora dados derivados de várias fontes e estudos científicos, inclusive coortes e registros, relacionados às DCV e fatores de risco

Introduction 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.

Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.