Gender and outcome in adult congenital heart disease

Background - Gender differences in prognosis have frequently been reported in cardiovascular disease but less so in congenital heart disease. We investigated whether gender is associated with outcome in adult patients with congenital heart disease. Methods and Results - From the CONgenital CORvitia (CONCOR) national registry for adults with congenital heart disease, 7414 patients were identified. All outcomes before entry into the registry and during subsequent follow-up were recorded, and differences between men and women were analyzed with the underlying congenital heart defect taken into account. Median age at the end of follow-up was 35 years (range, 17 to 91 years); 49.8% were female. No gender difference in mortality was found. Women had a 33% higher risk of pulmonary hypertension (odds ratio [OR] = 1.33; 95% CI, 1.07 to 1.65; P = 0.01), a 33% lower risk of aortic outcomes (OR = 0.67; 95% CI, 0.50 to 0.90; P = 0.007), a 47% lower risk of endocarditis (OR = 0.53; 95% CI, 0.40 to 0.70; P < 0.001), and a 55% lower risk of an implantable cardioverter-defibrillator ( OR = 0.45; 95% CI, 0.26 to 0.80; P = 0.006). Furthermore, the risk of arrhythmias appeared to be lower in women (OR = 0.88; 95% CI, 0.77 to 1.02; P = 0.08). Conclusions - The risk of several major cardiac outcomes in adult patients with congenital heart disease appears to vary by gender.