In Reply We thank Gorog and Lüscher and Navarese and Kereiakes for their thoughtful commentaries on our analysis of time to quadruple guideline-directed medical therapy (GDMT) in US veterans with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Both letters highlight a central point, that the implementation gap in GDMT optimization is not solely one of underprescription due to financial constraints, but reflects wider structural and operational limitations in how health care is delivered today and particularly during transitions of care following hospitalization.