To the Editor We read with great enthusiasm the Original Investigation by Mandalenakis et al1 in a recent issue of JAMA Internal Medicine. Comparing patients with congenital heart disease (CHD) born between 1970 and 1993 with matched controls, Mandalenakis et al1 showed an absolute and relative increase in survivorship in patients with CHD. Not surprisingly, the highest mortality risk was found among young children and in the most complex defects. Using a large nationwide Swedish registry and a robust design, this study1 supports our findings from the Quebec CHD Database2: deaths in CHD have shifted away from infants and toward adults, with a steady increase in age at death and decreasing mortality.