Prevalence and Management of Congenital Heart Diseases in Pakistan: A Comprehensive Cross-Sectional Study

Abstract

Background: Congenital heart diseases (CHDs) are among the most common birth anomalies globally, with higher prevalence and poorer outcomes in low- and middle-income countries due to delayed diagnosis, inadequate care infrastructure, and limited access to pediatric cardiac surgery. Despite the significant disease burden in Pakistan, national-level data on CHD prevalence and management remain scarce. Objective: This study aimed to determine the prevalence, types, diagnostic timing, and management patterns of CHDs in Pakistani children, while assessing the impact of socioeconomic status on access to timely diagnosis and appropriate treatment. Methods: A cross-sectional, observational study was conducted at five tertiary care hospitals in Pakistan from January 2023 to December 2024. A total of 1,200 children aged ≤12 years with echocardiographic ally confirmed CHDs were enrolled. Patients with acquired heart diseases were excluded. Data were collected using structured questionnaires and hospital records, assessing CHD types, age at diagnosis, treatment modalities, and socioeconomic variables. Ethical approval was obtained from relevant institutional review boards, and the study adhered to the Declaration of Helsinki. Statistical analysis was performed using SPSS v25, employing descriptive statistics and chi-square tests to determine associations (p < 0.001). Results: VSD was the most common CHD (32.5%), followed by ASD (22.4%) and TOF (15.8%). The mean age at diagnosis was 2.5 years, with rural children diagnosed significantly later (3.2 years) than urban counterparts (1.8 years). Surgical intervention was performed in 45% of cases, while 55% received medical management. Socioeconomic status was significantly associated with both delayed diagnosis (χ² = 81.75, p < 0.001) and inadequate treatment (χ² = 99.75, p < 0.001), indicating profound healthcare disparities. Conclusion: The study reveals a high burden of CHDs in Pakistan, compounded by late diagnosis and limited surgical access, particularly among socioeconomically disadvantaged populations. These findings underscore the need for national CHD screening programs, fair healthcare distribution, and policy interventions to improve outcomes and reduce mortality.