Health-related quality of life and psychosocial outcomes after treatment for congenital heart disease among school-aged children and adolescents in China: an online cross-sectional comparative study.

BACKGROUND: As survival after treatment for congenital heart disease (CHD) continues to improve, long-term outcomes beyond survival have become increasingly important. Evidence from mainland China remains limited, particularly for school-aged children and adolescents after treatment for CHD. This study evaluated health-related quality of life (HRQoL), depressive symptoms, and self-esteem in this population. METHODS: This online cross-sectional comparative study included children and adolescents aged 7-18 years who had undergone surgical or minimally invasive treatment for CHD at least 6 months previously and controls of comparable age without known CHD or other reported chronic medical conditions. HRQoL was assessed using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL 4.0), depressive symptoms using the Center for Epidemiologic Studies Depression Scale for Children (CES-DC), and self-esteem using the Rosenberg Self-Esteem Scale (RSES). Continuous variables were summarized as median (interquartile range, IQR), and between-group comparisons were performed using non-parametric tests. Age- and sex-adjusted linear regression models were fitted for the major outcomes. RESULTS: A total of 78 post-treatment CHD patients and 90 controls were included. Compared with controls, post-treatment CHD patients had lower PedsQL 4.0 scores across Physical, Emotional, Social, and School Functioning domains, as well as Physical Health, Psychosocial Health, and Total Scores (all P < 0.001). In the age- and sex-adjusted model, controls had a higher PedsQL Total Score than post-treatment CHD patients (B = 13.31, 95% CI: 8.25-18.36, P < 0.001). No statistically significant difference in CES-DC scores was observed between groups [10.5 (3.25-17.75) vs. 8.0 (4.0-14.0), P = 0.285]. RSES scores were lower in post-treatment CHD patients than in controls [31.0 (28.0-36.75) vs. 36.0 (30.0-39.0), P = 0.001]. The adjusted model also showed higher RSES scores among controls (B = 2.83, 95% CI: 1.17-4.48, P = 0.001). CONCLUSION: In this online sample, school-aged children and adolescents after treatment for CHD reported poorer HRQoL and lower global self-esteem scores than controls without known CHD. No statistically significant difference in depressive symptom scores was observed. These findings support post-treatment care models that extend beyond cardiac status and incorporate functional recovery, school participation, family education, physical activity guidance, and psychosocial screening.