From Survival to Lifelong Care: The Global Burden of Congenital Heart Disease.

Congenital heart disease (CHD) is the most common congenital anomaly and remains an under-recognised contributor to the global burden of cardiovascular disease. Once regarded as a paediatric condition, its burden now extends across the life course, as growing numbers of patients survive into adulthood and require lifelong, specialised care. Here we examine the global burden of CHD and propose actionable strategies. Data from the Global Burden of Disease (GBD) study, supplemented by peer-reviewed literature, global reports, and expert input, were used. We examined trends in CHD incidence, prevalence, mortality, and disability-adjusted life years (DALYs), from 1990 to 2023. In 2023, an estimated 2.3 million children were born with CHD, and 16 million people were living with the condition worldwide, up from 11.8 million in 1990, with the largest increase in lower-middle-income regions. CHD has remained the leading cause of neonatal and infant mortality among non-communicable diseases across all regions since 1990. Age-standardised mortality reached 4.7 deaths per 100,000 people globally in 2023, remaining four times higher in low-income (5.7) than in high-income (1.4) regions. Profound inequities persist across the accessibility, capacity, quality, and affordability of care, as high-income countries have 140-180 times as many cardiac surgeons as low-income countries. Coordinated initiatives such as Kerala's Hridyam programme have shown that meaningful gains are achievable even in resource-limited settings. Persistent care disparities are driven less by an absence of clinical knowledge than by unequal access to timely diagnosis, treatment, and lifelong follow-up. Addressing the global CHD crisis will require coordinated efforts from policymakers, healthcare systems, and global health organisations, supported by the proposed 2027 World Health Assembly resolution on childhood-onset heart disease.