The goal of the PIONEER-HF (Comparison of Sacubitril–Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized From an Acute Heart Failure Episode) study was to assess the safety and effectiveness of sacubitril–valsartan in comparison with enalapril in hospitalized patients with worsening HF, more than half of whom were not receiving neither an ACEi nor an ARB at the point of enrollment [10]. Here, NPPB is linked to hydrops fetalis.