ABC | Volume 115, Nº2, August 2020

Letter to the Editor Souza et al. Circulatory System Diseases and COVID-19 Arq Bras Cardiol. 2020; 115(2):281-283 obstructive pulmonary disease (2.9%; n = 12), and cancer (2.2%; n = 9), which were also observed in our study. Mortality was higher in individuals with heart injury (51.2% in the group with injury vs. 4.5% in the group without injury), and preexisting diseases were factors associated with higher mortality. 4 The association between several comorbidities/ risk factors may explain the compromised respiratory condition upon admission, with dyspnea and oxygen saturation < 95%, which indicates severely compromised pulmonary function in these patients. The close functional relationship between the cardiovascular (doubly affected by the baseline disease and by SARS-CoV-2 infection) and pulmonary systems (accentuated pulmonary injury) should be prioritized during the process of caring for patients with COVID-19 who have circulatory system disease. 3-5 Finally, we underline the need to adopt and/or strengthen mechanisms that reduce contamination of individuals with circulatory system diseases by COVID-19. For those who are already contaminated, early diagnosis and monitoring of clinical picture should be rigorously followed, in order to avoid worsening and death in these individuals. Table 1 - Clinical and epidemiological characteristics of patients with circulatory system diseases who died from COVID-19 in Pernambuco. Pernambuco, Brazil, 2020 (n = 197) Variable n % Sex Female 105 53.3 Male 92 46.7 Age (years) 20-29 2 1.0 30-39 3 1.5 40-49 10 5.2 50-59 26 13.2 60-69 53 26.9 70-79 58 29.4 80+ 45 22.8 Signs/symptoms Fever 132 67.0 Dyspnea 159 80.7 Cough 142 72.1 Oxygen saturation < 95% 116 58.9 Sore throat 12 6.1 Asthenia 9 4.6 Diarrhea 9 4.6 Nausea/vomiting 7 3.6 Headache 3 1.5 Myalgia 3 1.5 Weight loss 2 1.0 Abdominal pain 1 0.5 Runny nose 1 0.5 Constipation 1 0.5 Number of comorbidities Only one 42 21.3 Two 81 41.1 Three or more 74 37.6 Cardiovascular and hematological system Systemic arterial hypertension 163 82.7 Unspecified heart disease 51 25.9 Chronic venous insufficiency 5 2.5 Coronary artery disease 4 2.0 Thrombosis 3 1.5 Arrhythmia 2 1.0 Chagas disease 1 0.5 Anemia 1 0.5 Endocrine/metabolic system Diabetes mellitus 106 53.8 Obesity 22 11.2 Dyslipidemia 2 1.0 Hypothyroidism 1 0.5 Respiratory system Tobacco use 15 7.6 Chronic obstructive pulmonary disease 9 4.6 Pneumonia 2 1.0 Tuberculosis 1 0.5 Asthma 1 0.5 Neurological disease Stroke (prior event) 16 8.1 Unspecified mental disease 5 2.5 Unspecified neurological disease 4 2.0 Alzheimer’s 4 2.0 Myasthenia 1 0.5 Other conditions/risk factors Chronic renal disease 21 10.7 Cancer 8 4.1 Alcoholism 5 2.5 Unspecified dermatological disease 3 1.5 Liver disease 2 1.0 Amputated limb 3 1.5 Other conditions with only one reported case (HIV, pancreatitis, prior transplant, osteoporosis, bedridden). 1 0.5 Time from onset of symptoms to death (average and standard deviation, in days) 9.7 ± 7.8 282