Abstract Body (Do not enter title and authors here): Background: Congenital heart anomalies (CHA) remain one of the leading causes of childhood morbidity and mortality worldwide, with significant implications for long-term health outcomes and healthcare systems.
Method: Utilizing global burden of disease 2021 study standardized methodology we estimated CHA burden for all 27 European Union countries from1990-2021. Age-standardized rates of deaths, prevalence, and years lived with disability (YLDs) were analyzed, and annualized percentage changes (APC) were calculated for multiple time intervals to assess temporal and sex-specific trends.
Result: From 1990 to 2000, the APC in deaths due to CHA declined significantly by -5.72%, followed by a continued but less steep decline of -3.90% from 2000 to 2021. In contrast, the prevalence showed a slight annual decrease of -0.12% during 1990–2000, which reversed to a modest annual increase of 0.19% in the period 2000–2021. YLDs demonstrated a similar trend, with an annual decline of -0.58% from 1990 to 2000 and a slight increase of 0.12% annually from 2000 to 2021. The age-standardized death rate (ASMR) declined annually by -5.10% from 1990 to 2000 and -4.00% from 2000 to 2021, while the age-standardized prevalence rate (ASPR) remained largely stable during 1990–2000 (0.006% per year) and rose slightly thereafter (0.11% per year); similarly, YLDs (ASYLDsR) showed a mild decline in the first decade (-0.17%) followed by a gradual annual increase of 0.19% from 2000 to 2021. Nationally, the highest APC in ASPR observed in Austria by 0.66%, followed by Ireland 0.23%, Portugal 0.22%, Croatia 0.19%, Malta 0.16%. From 2000 to 2010, the ASMR declined annually by -4.30% in males and -4.58% in females, with a slower decline observed from 2010 to 2021 (-3.48% in males, -3.80% in females). The prevalence rate showed a modest annual increase in males (0.28%) and a slight decline in females (-0.05%) during 2000–2010, followed by a small rise in both sexes from 2010 to 2021 (0.02% in males, 0.18% in females). YLDs remained stable in females (-0.007%) and increased marginally in males (0.23%) from 2010 to 2021.

Conclusion: While the mortality due to CHA has steadily declined across 3 decades and sexes, both prevalence and disability burden have shown a gradual upward trend since 2000, particularly among males. These findings highlight a shifting burden from fatal to non-fatal outcomes, underscoring the need for long-term care strategies and quality-of-life interventions.