NPPB and hydrops fetalis: Although the PIONEER-HF (Comparison of Sacubitril/Valsartan Versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode) trial showed that ARNi can be safely initiated during admission and is associated with a reduction in cardiac biomarker and HF rehospitalization 42, we need to carefully interpret this result because the primary endpoint of the PIONEER-HF trial was not related to clinical outcomes.