title: Secundum atrial septal defect is associated with reduced survival in adult men.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands - Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: Joey M
authors.initials: JM
authors.lastname: Kuijpers
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Teun
authors.initials: T
authors.lastname: van der Bom
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands - Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: Annelieke C M J
authors.initials: AC
authors.lastname: van Riel
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: Meijboom
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Arie P J
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: W Marc
authors.initials: WM
authors.lastname: Waskowsky
authors.affiliation: Department of Cardiology, Antonius Hospital, Sneek, The Netherlands.
authors.forename: Toon
authors.initials: T
authors.lastname: Oomen
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: A Carla
authors.initials: AC
authors.lastname: Zomer
authors.affiliation: Department of Cardiology, Medical Spectrum Twente, Eschede, The Netherlands.
authors.forename: Lodewijk J
authors.initials: LJ
authors.lastname: Wagenaar
authors.affiliation: Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands.
authors.forename: Wilfred F
authors.initials: WF
authors.lastname: Heesen
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands - Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands b.j.bouma@amc.uva.nl.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
keywords: Atrial septal defect; Epidemiology; Gender; Morbidity; Survival