ACE and hydrops fetalis: The rate of MRAs, which was added in the 2017 revised Guidelines for Diagnosis and Treatment of Acute and Chronic HF [1], with Class I evidence level A for HFrEF patients, similar to ACE inhibitors, ARBs, and β-blockers, was 45% or higher in Kanto (45.85%), Chugoku (45.33%), and Kyushu (45.72%), but lower in Tohoku (40.96%), Kinki (40.84%), and Shikoku (40.90%).