ACE and hydrops fetalis: The Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial demonstrated that sac/val was able to reduce the composite endpoint of CV death or first hospitalization for HF by 20% and the relative risk of all-cause mortality by 16% in comparison with enalapril, during a 27 months median of follow-up, in HRrEF outpatients.