To the Editor Jacobs and colleagues quantify a persistent and clinically relevant gap in the implementation of quadruple guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF), with fewer than 1 in 4 patients achieving full therapy and a median delay of nearly 7 months. As emphasized by Kalwani et al, time to quadruple therapy should be interpreted not only as a descriptive metric, but as an indicator of health system performance.