Randomized clinical studies in people with heart failure and a low ejection fraction might not even represent people with heart failure and a low ejection fraction in general. The GALACTICHF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patient population in Kaiser Permanente Southern California was evaluated for representativeness. Using electronic health records, researchers found 9,770 patients diagnosed with heart failure with a lower ejection fraction from 2014 to 2018. GALACTICHF–ineligible cohorts: not taking guideline-directed medical therapy (GDMT) and taking GDMT, as well as GALACTICHF–eligible cohorts with: ejection fraction (EF) less than or equal to 28% and EF 29% to 35% were formed. Patients were tracked for 30 days and 1 year to see if they died and 30 days, 180 days, and 1 year to see if they were hospitalized. Overall, 3,626 (37.1%) of those who satisfied GALACTICHF inclusion criteria had an EF of less than or equal to 35%, while 2,367 (65.3%) had an EF of less than or equal to 28%. All cohorts had a lower risk of 1-year mortality than the GALACTICHF–ineligible cohort not taking GDMT (hazard ratio, 0.80 [95% CI, 0.70–0.91], 0.84 [95% CI, 0.72–0.98], and 0.62 [95% CI, 0.51–0.75] for the GALACTICHF–ineligible cohort taking GDMT and GALACTICH Feligible cohorts with EF less than or equal to 28% and 29–35%, respectively). The short-term hospitalization risk at 30 and 180 days was equivalent for both GALACTICHF–eligible cohorts. The hospitalization risk at 1 year was similar for the GALACTICHF–an eligible group with EF less than or equal to 28% compared to the GALACTICHF–ineligible cohort not taking GDMT. Despite being on GDMT, most patients with heart failure with low EF satisfied the inclusion criteria for the GALACTICHF study. They had hospitalization rates comparable to those not on GDMT, suggesting potential benefits from other novel treatments.