This focused review examines the results of the PHARM-HF A&F Study, a randomized trial evaluating audit and feedback interventions to optimize heart failure medication management among primary care pharmacists in the Veterans Affairs (VA) healthcare system. Despite strong evidence that quadruple guideline-directed medical therapy (GDMT) can reduce mortality by ~ 70% in patients with heart failure with reduced ejection fraction (HFrEF), implementation remains suboptimal, particularly in rural areas. While both trial arms showed improvements in heart failure medication management during the study period, audit and feedback led to modest increases in medication encounters and mineralocorticoid receptor antagonist initiation compared to education alone. This review explores these results in the context of broader efforts to improve heart failure care quality through pharmacist-led interventions in primary care settings.