To the Editor We read with interest the recent study by Jacobs et al that examined time to quadruple guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) using data from the US Veteran’s Health Administration. The authors identify a very important and persistent gap: only 21.2% of patients achieved quadruple therapy, with a median time to quadruple therapy (TTQ) of 197 days. These findings highlight substantial delays in treatment optimization despite well-established benefits.