Delayed diagnosis of congenital heart disease: clinical, social, and health system implications in middle-income countries (A literature review)
DOI:
https://doi.org/10.37800/RM.2.2026.722Keywords:
congenital heart disease , early diagnosis, health services accessibility, socioeconomic factorsAbstract
Relevance: Delayed diagnosis of congenital heart disease remains a significant challenge that affects clinical outcomes and contributes to long-term socioeconomic burden, particularly in middle-income countries. Although prenatal and neonatal screening technologies have improved, significant differences in early detection persist across healthcare systems.
This study aimed to explore the diagnostic and systemic factors associated with delayed detection of congenital heart disease and to examine the resulting clinical, socioeconomic, and demographic consequences in middle-income settings.
Materials and Methods: A literature search was performed in PubMed and Scopus, with additional identification of open-access studies through the Directory of Open Access Journals. The search covered publications from January 2020 to December 2025. Original studies and systematic reviews addressing screening practices, institutional organization, geographic accessibility of services, financial mechanisms, and long-term outcomes were considered. The available evidence was reviewed and summarized using a narrative synthesis approach.
Results: Delayed diagnosis was commonly linked to institutional and organizational challenges within healthcare systems. These included uneven implementation of neonatal screening, differences in prenatal detection rates, shortages of specialized personnel, fragmented referral pathways, and regional disparities in access to tertiary care. Sociodemographic factors such as parental education, household income, and insurance coverage also influenced the timing of diagnosis. Late detection was frequently associated with more severe clinical presentation, greater healthcare resource use, increased mortality risk, and long-term disability. At the population level, these processes contribute to productivity losses and widen existing health inequalities.
Conclusions: Delayed diagnosis of congenital heart disease should be viewed as a systemic issue reflecting the structure and functioning of healthcare delivery. Reducing diagnostic delays may help limit disease severity, prevent long-term disability, and lessen the broader demographic and economic burden in middle-income countries.
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