I read with interest the analysis from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE-HF) program by Albert et al. The investigators suggested that having ≥2 advanced practice nurses (APN) or physician assistants (PAs) in cardiology practices was associated with greater use of implantable cardioverter-defibrillator therapy and delivery of heart failure education compared with practices with no APNs or PAs. The significant association of having ≥2 APNs or PAs with heart failure clinic, however, questions the generalizability of this finding. The investigators need to ensure that this finding is not heavily influenced by APNs or PAs practicing in heart failure clinics. The reader gets the impression that the findings apply to cardiology outpatient practices at large. To reach that conclusion, this association should be demonstrated in cardiology practices not associated with heart failure clinics; otherwise, the findings would more accurately reflect the performance of heart failure clinics.