Health-related quality of life in children with cyanotic CHD compared with healthy peers: a case–control study, Sulaimani, Iraq

Background: Children with cyanotic CHD experience chronic hypoxaemia and recurrent medical interventions that may adversely affect health-related quality of life. Aims: To compare health-related quality of life between children with cyanotic CHD and healthy peers in Sulaimani, Iraq. Methods: A hospital-based case–control study was conducted between October 2023 and April 2024, including 200 children with cyanotic CHD and 200 age- and sex-comparable healthy controls aged 3–13 years. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL™), including the Generic Core Scale Version 4.0 and the Cardiac Module Version 3.0, through parent-reported interviews. Group differences were examined using independent-samples t -tests and analysis of covariance, adjusting for age, sex, peripheral oxygen saturation (SpO 2 ), and educational level. Results: Children with cyanotic CHD had significantly lower health-related quality-of-life scores across all domains compared with healthy children (all p -values < 0.001). After adjustment, the largest differences were observed in physical functioning and total quality of life, with large effect sizes (partial η 2 = 0.50 and 0.63, respectively). Mean SpO 2 levels were also significantly lower among children with cyanotic CHD ( p < 0.001). Conclusions: Cyanotic CHD was independently associated with substantial impairment in quality of life across physical and psychosocial domains. Lower peripheral oxygen saturation (SpO 2 ) was independently associated with poorer health-related quality of life. These findings support integrating health-related quality-of-life assessment and multidisciplinary care into the routine management of children with cyanotic CHD.