Secundum Atrial Septal Defect: Sex-Specific Prognosis | Journal Scan

Study Questions:

Does gender affect long-term outcome in adult patients with secundum atrial septal defect (ASD)?

Methods:

This was a prospective assessment of survival and cumulative incidence and risk of clinical events in patients with secundum ASD using the Dutch CONCOR database of individuals with adult congenital heart disease. Survival stratified by gender was compared with a gender-matched general population.

Results:

A total of 2,207 patients with secundum ASD classified as the primary defect were selected from the CONCOR database. Patients had a mean age at inclusion of 44.8 years (33.0% male) and there were 102 deaths 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 secundum ASD. Compared with the age- and gender-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 (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.22-2.17), supraventricular dysrhythmias (OR, 1.41; 95% CI, 1.12-1.77), cerebrovascular thromboembolic events (OR, 1.53; 95% CI, 1.10-2.12), and heart failure (OR, 1.91; 95% CI, 1.06-3.43).

Conclusions:

Compared with women, adult men with a secundum ASD have worse survival and a greater risk of morbidity than a gender-matched general population.

Perspective:

Secundum ASDs remain one of the most commonly diagnosed congenital heart defects in adulthood. However, there are few prospective randomized trials to guide management. Using the CONCOR database, the authors prospectively addressed whether gender had an affect on morbidity and mortality. Male gender not only had lower survival, but also more complications, including arrhythmias, cerebrovascular events, and heart failure. While females were more likely to have pulmonary hypertension associated with secundum ASD, males with pulmonary hypertension had a higher mortality. This study included both individuals who had surgical ASD closure as well as those who had not received an intervention. As the CONCOR database does not account for smoking, comorbidities, perioperative complications, or pulmonary arterial pressures or right ventricular dilation, the extension of this research to clinical management recommendations regarding potential advantages of ASD closure in adulthood is limited. However, the gender disparity in survival and morbidity demonstrated here does suggest the need to focus clinically and in future research on better understanding of why this disparity may exist. This research also highlights the growing burden of complications with age and heterogeneity of presentation and management needs in what was once thought to be a relatively low complexity diagnosis.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Pulmonary Hypertension, Smoking

Keywords: Arrhythmias, Cardiac, Arterial Pressure, Bisoprolol, Comorbidity, Heart Conduction System, Heart Defects, Congenital, Heart Septal Defects, Atrial, Heart Failure, Hypertension, Pulmonary, Incidence, Logistic Models, Prospective Studies, Smoking, Survival


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