A related commentary discusses this research. Available data for community-based patients with heart failure have not demonstrated the same magnitude of temporal outcome improvements as in clinical trials. If the optimal clinical trial–based approach of aiming for, achieving, and maintaining target doses of guideline-directed heart failure medical therapies, as tolerated, were to be fully implemented in clinical practice, the benefits on population health would be substantial. There is a critical need for greater focus on achieving guideline directed target dosing of therapies via focused quality measures, heart failure disease management programs, and performance improvement systems. As demonstrated in this trial however, serial monitoring of natriuretic peptide biomarkers do not appear to add incremental value to such efforts.