We thank Steffen et al. for their interest in our study on guideline-directed medical therapy (GDMT) in patients with heart failure (HF) during hospitalised exacerbations (ECOPD) [1,2] We acknowledge the mentioned limitations of our observational design, including the potential for residual confounding and treatment selection bias [2] Nevertheless, our real-world findings underscore a clinically relevant treatment gap among COPD–HF patients, with poorer outcomes likely reflecting the high clinical vulnerability of this population and the need for more evidence on optimal therapeutic choices [3,4]
