Impact of a national policy on congenital heart disease mortality in Brazil

Objective: The objective of this study was to evaluate the impact of the implementation of a National Plan for the Assistance of Children with Congenital Heart Disease (CHD) in Brazil on infant mortality rates. Methods: This retrospective cohort study analyzed data from the Mortality Information System (SIM) for the period 2012–2023. In 2017, the Brazilian Ministry of Health launched a National Health Policy through Ordinance No. 1727, aiming to expand pediatric cardiac surgery capacity and reduce regional disparities in care for CHD. The study included all deaths among children under 1 year of age with CHD, identified using the International Classification of Diseases-10 codes Q20–Q28. We compared the mean infant mortality rates between two periods: before (2012–2017) and after (2018–2023) the policy implementation. In addition, we examined the relationship between CHD mortality and socioeconomic indicators, including the Human Development Index (HDI) and the Social Vulnerability Index (SVI). Results: There was no significant reduction in infant mortality rates between the two periods. When analyzing mortality rates by Brazilian region, no statistically significant differences were observed before and after the ordinance, except for the north region, which showed a worsening trend (112.9 vs. 125.3 deaths per 100,000 live births; P = 0.07). HDI showed a weak and nonsignificant correlation with CHD mortality ( r = 0.12; P = 0.41), and the correlation with SVI was also not statistically significant ( r = −0.03; P = 0.85). Conclusions: So far, no significant change in infant mortality due to CHD has been observed in Brazil following the implementation of the National Plan for the Assistance of Children with CHD.