Abstract Body (Do not enter title and authors here): Introduction: Congenital Heart Anomalies (CHA) are the leading cause of deaths among all congenital birth defects (CBD) in the United States. This study represents the first-ever effort to estimate the burden of CHA nationwide over the past three decades, including the first two years of the COVID-19 pandemic.

Method: Using Global Burden of Disease 2021 tool, we estimated incidence, prevalence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to CHA by age, sex, year and location across the US from 1990-2021. The results were presented in absolute counts and age-standardized rates (per 100,000).

Results: The total prevalence of cases rose from 441,000 (95% Uncertainty Interval: 391,325-492,037) in 1990 to 527,452 (475,661-579,228) in 2021. Over the same period, the total percentage change (TPC) in deaths decreased by 56%, while YLDs increased by 11% (3-17%). The largest increase in TPC in incidence rates was observed in Wisconsin at 19% (6-37%), followed by a YLD rate increase in Delaware of 4% (7-15%). By age, individuals under 20 years experienced the highest death count at 1,551 (1,295-1,942), those aged 20-54 years observed 695 deaths (623-827), and those over 55 years saw 378 deaths (332-519) in 2021. In terms of gender, females showed a higher increase in TPC for YLDs compared to males (11% vs 10%), although both genders observed decreases in incidence and deaths.

Conclusion: Deaths due to CHA accounted for 31% of all CBD in the US in 2021. Study findings reveal a notable decrease in mortality but an increase in disability years, reflecting advances in treatment alongside ongoing challenges in managing long-term health outcomes. This underscores the need for a dual approach in public health: enhancing preventive strategies and improving management for those affected. Coordinated efforts among healthcare providers, policymakers, and community health programs are essential to address these needs effectively.