The Next Global Health Priority: Why Congenital Heart Disease Must Be Included in National Non-Communicable Disease Strategies

Abstract

Abstract Congenital heart disease (CHD) is the most common congenital anomaly worldwide, affecting approximately 1 in every 100 live births. Advances in prenatal diagnosis, neonatal care, cardiac surgery, catheter-based interventions, and lifelong follow-up have transformed CHD from a fatal childhood condition into a chronic disease spanning the entire lifespan. Despite these achievements, congenital heart disease remains largely overlooked in national and global non-communicable disease (NCD) strategies, which predominantly focus on cardiovascular diseases of adulthood, diabetes, chronic respiratory diseases, and cancer. This omission is particularly detrimental in low- and middle-income countries (LMICs), where delayed diagnosis, limited specialized services, financial barriers, and inadequate workforce capacity continue to contribute to preventable mortality and lifelong disability. As survival improves globally, the number of adults living with congenital heart disease now exceeds the pediatric population, creating an emerging public health challenge. Integrating congenital heart disease into national NCD frameworks would facilitate comprehensive planning for prevention, early detection, specialized treatment, workforce development, sustainable financing, registries, and lifelong care. This editorial highlights why congenital heart disease should be recognized as the next global health priority and outlines practical recommendations for policymakers. Editorial Congenital heart disease is no longer a rare pediatric condition but a major global health challenge [1,2]. Advances in medical care have transformed CHD into the largest population of survivors with lifelong congenital cardiovascular disease, creating new responsibilities for health systems [3-5]. For decades, global non-communicable disease (NCD) strategies have concentrated on four major disease groups—cardiovascular disease, diabetes mellitus, chronic respiratory diseases, and cancer [6]. These priorities have undoubtedly improved health outcomes worldwide. However, an important and growing population has remained largely invisible within national health agendas: individuals living with congenital heart disease (CHD). Congenital heart disease is the commonest congenital anomaly, affecting nearly 1.35 million newborns annually worldwide [1,2]. Improvements in fetal diagnosis, neonatal intensive care, cardiac surgery, interventional cardiology, and medical management have dramatically increased survival [3-5]. Today, more than 90% of children born with CHD in high-income countries survive into adulthood [3-5]. Consequently, congenital heart disease has evolved from a pediatric disorder into a lifelong chronic cardiovascular disease requiring continuous multidisciplinary care [3,5,7]. Yet, national NCD strategies rarely acknowledge this changing epidemiology. A Growing but Neglected Global Health Burden: Although rheumatic heart disease has received increasing recognition within global cardiovascular health initiatives, congenital heart disease has remained underrepresented despite its substantial burden [6,8]. Every year, hundreds of thousands of children die because they lack timely diagnosis or access to definitive treatment [2,9]. Many survivors experience chronic heart failure, pulmonary hypertension, arrhythmias, infective endocarditis, stroke, neurodevelopmental impairment, or repeated hospitalizations that significantly reduce quality of life [5,7]. The disparity is greatest in low- and middle-income countries (LMICs), where nearly 90% of children with congenital heart disease are born [2,9-11]. Unfortunately, specialized pediatric cardiac centers, trained congenital cardiologists, congenital cardiac surgeons, advanced imaging facilities, and pediatric intensive care units remain scarce across many regions. The result is an unacceptable gap between disease burden and healthcare capacity. Congenital Heart Disease Fits the Definition of a Chronic Non-Communicable Disease: The exclusion of congenital heart disease from NCD policies is increasingly difficult to justify. Modern congenital heart disease fulfills every characteristic of a chronic non-communicable disease [5-7]: Lifelong disease requiring continuous follow-up Recurrent need for specialist healthcare Substantial healthcare expenditure Progressive complications throughout life Impact on education, employment, pregnancy, and mental health Requirement for multidisciplinary coordinated care Many adults with repaired congenital heart disease require repeated interventions, electrophysiology procedures, heart failure management, pulmonary hypertension therapy, cardiac transplantation assessment, and lifelong surveillance. Their healthcare needs resemble those of patients with other chronic cardiovascular diseases already included within NCD frameworks. Why National NCD Strategies Matter? Inclusion within national NCD strategies extends beyond symbolic recognition. It determines health financing, workforce planning, service delivery, data collection, and political commitment. Recognition of congenital heart disease as a national NCD priority would encourage governments to establish: National congenital heart disease registries Newborn pulse oximetry screening programs Prenatal cardiac screening pathways Regional referral networks Dedicated pediatric and adult congenital heart disease centers Specialized workforce training Sustainable financing mechanisms Lifelong transition services from pediatric to adult care. Such policies are especially important for countries where specialized congenital cardiac services remain centralized, forcing families to travel long distances for diagnosis and treatment [6,12,13]. The Challenge in Low and Middle Income Countries: The challenges faced by LMICs differ substantially from those in high-income countries. Delayed diagnosis, malnutrition, pulmonary vascular disease, limited catheterization facilities, shortage of pediatric cardiac surgeons, inadequate intensive care resources, and financial hardship frequently convert treatable congenital heart defects into irreversible disease. Many countries continue to rely on a few tertiary centers that struggle with overwhelming patient volumes. Rural populations often remain undiagnosed until advanced complications develop. Without incorporation into national health planning, these inequities are unlikely to improve [8-11]. Congenital Heart Disease and Universal Health Coverage: Universal Health Coverage (UHC) aims to ensure that all individuals receive essential health services without financial hardship. Congenital heart disease perfectly aligns with this principle. Early diagnosis and timely intervention are among the most cost-effective investments in cardiovascular medicine. Repairing a ventricular septal defect or transposition of the great arteries during infancy allows children to become healthy, productive adults who contribute economically and socially for decades. Conversely, delayed treatment frequently results in irreversible pulmonary vascular disease, lifelong disability, repeated hospitalization, and substantially higher healthcare costs. Investment in congenital heart disease is therefore not only ethically imperative but economically rational [12,13]. The Need for Global Policy Change: The World Health Organization and international cardiovascular societies have successfully elevated hypertension, ischemic heart disease, stroke, and rheumatic heart disease within global health priorities. A similar coordinated effort is now required for congenital heart disease. Future national NCD action plans should explicitly incorporate congenital heart disease through measurable indicators, dedicated funding, surveillance systems, workforce development, research support, and quality improvement programs. Partnerships between governments, academic institutions, international organizations, patient advocacy groups, and professional societies will be essential for achieving these objectives [6,12,13]. Conclusion As countries strive to achieve Universal Health Coverage and the Sustainable Development Goals, congenital heart disease can no longer remain outside national non-communicable disease agendas. Recognizing CHD as a lifelong chronic cardiovascular disease is not merely a semantic change—it is a public health imperative that will determine whether millions of children born with congenital heart defects survive, thrive, and contribute to society. 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