Joey M Kuijpers1, Teun van der Bom2, Annelieke C M J van Riel1, Folkert J Meijboom3, Arie P J van Dijk4, Petronella G Pieper5, Hubert W Vliegen6, W Marc Waskowsky7, Toon Oomen8, A Carla Zomer9, Lodewijk J Wagenaar10, Wilfred F Heesen11, Jolien W Roos-Hesselink12, Aeilko H Zwinderman13, Barbara J M Mulder1, Berto J Bouma14. 1. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands - Netherlands Heart Institute, Utrecht, The Netherlands. 2. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 3. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. 4. Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. 6. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Cardiology, Isala Clinics, Zwolle, The Netherlands. 8. Department of Cardiology, Antonius Hospital, Sneek, The Netherlands. 9. Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. 10. Department of Cardiology, Medical Spectrum Twente, Eschede, The Netherlands. 11. Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands. 12. Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. 13. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands. 14. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands b.j.bouma@amc.uva.nl.
Abstract
AIMS: The identification of sex differences in the prognosis of adults with a secundum atrial septal defect (ASD2) could help tailor their clinical management, as it has in other cardiovascular diseases. We investigated whether disparity between the sexes exists in long-term outcome of adult ASD2 patients. METHODS AND RESULTS: Patients with ASD2 classified as the primary defect were selected from the Dutch national registry of adult congenital heart disease. Survival stratified by sex was compared with a sex-matched general population. In a total of 2207 adult patients (mean age at inclusion 44.8 years, 33.0% male), 102 deaths occurred during a cumulative follow-up of 13 584 patient-years. Median survival was 79.7 years for men and 85.6 years for women with ASD2. Compared with the age- and sex-matched general population, survival was lower for male, but equal for female patients (P = 0.015 and 0.766, respectively). Logistic regression analyses showed that men had a higher risk of conduction disturbances (OR = 1.63; 95% CI, 1.22-2.17) supraventricular dysrhythmias (OR = 1.41; 1.12-1.77), cerebrovascular thromboembolic events (OR = 1.53; 1.10-2.12), and heart failure (OR = 1.91; 1.06-3.43). CONCLUSION: In contrast to women, adult men with an ASD2 have worse survival than a sex-matched general population. Male patients also have a greater risk of morbidity during adult life. Sex disparity in survival and morbidity suggests the need for a sex-specific clinical approach towards these patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The identification of sex differences in the prognosis of adults with a secundum atrial septal defect (ASD2) could help tailor their clinical management, as it has in other cardiovascular diseases. We investigated whether disparity between the sexes exists in long-term outcome of adult ASD2patients. METHODS AND RESULTS:Patients with ASD2 classified as the primary defect were selected from the Dutch national registry of adult congenital heart disease. Survival stratified by sex was compared with a sex-matched general population. In a total of 2207 adult patients (mean age at inclusion 44.8 years, 33.0% male), 102 deaths occurred during a cumulative follow-up of 13 584 patient-years. Median survival was 79.7 years for men and 85.6 years for women with ASD2. Compared with the age- and sex-matched general population, survival was lower for male, but equal for female patients (P = 0.015 and 0.766, respectively). Logistic regression analyses showed that men had a higher risk of conduction disturbances (OR = 1.63; 95% CI, 1.22-2.17) supraventricular dysrhythmias (OR = 1.41; 1.12-1.77), cerebrovascular thromboembolic events (OR = 1.53; 1.10-2.12), and heart failure (OR = 1.91; 1.06-3.43). CONCLUSION: In contrast to women, adult men with an ASD2 have worse survival than a sex-matched general population. Male patients also have a greater risk of morbidity during adult life. Sex disparity in survival and morbidity suggests the need for a sex-specific clinical approach towards these patients. Published on behalf of the European Society of Cardiology. All rights reserved.