Academic achievement of children with congenital heart disease (CHD) has not been comprehensively studied across the entire CHD severity spectrum.

Through nationwide registries, we identified all children with CHD who reached 16 years of age and matched each child with CHD to controls who attended an elementary school-leaving examination in the same year and municipality from 2001 to 2022. The school performance of children with CHD was evaluated based on the rank of their mean exam score and risk of failing the exam when compared with matched controls. Between 2001 and 2022, 10 717 children with CHD and 229 738 matched controls participated in the exam. Children with CHD ranked lower in the mean exam score compared with controls [0.47 (95% confidence interval (CI): 0.46–0.48) vs. 0.50 (95% CI: 0.50–0.50)], with a reduced rank value of 0.48 (0.47–0.48) for mild CHD, 0.46 (0.45–0.47) for moderate CHD, and 0.44 (0.42–0.47) for severe CHD (all P < 0.0001). Furthermore, 27.5% of the CHD children failed the exam compared with 19.0% of the controls [adjusted odds ratio (aOR): 1.45 (95% CI: 1.37–1.53), P < 0.0001], with an aOR for failing the exam of 1.35 (1.26–1.44) for mild CHD, 1.54 (1.39–1.72) for moderate CHD, and 2.27 (1.86–2.77) for severe CHD. Preterm birth, previous cardiac intervention, cardiopulmonary bypass, and hospitalization were associated with lower exam score and higher risk of failing the exam. Over time, school performance among CHD children worsened from 0.49 (95% CI: 0.47–0.51) to 0.47 (95% CI: 0.45–0.48).

School performance was impaired in all children with CHD, regardless of disease severity. These findings advocate for a better surveillance and school support for children with CHD to help improve their educational outcomes.