ACE and heart failure: Regarding human studies, ARNI was shown to be more effective in reducing the risk of death from cardiovascular causes or hospitalization for heart failure than was ACE inhibition with enalapril in patients with chronic heart failure and a reduced ejection fraction; ARNI is also superior to enalapril in reducing the risk of death from any cause and reducing symptoms and physical limitations of heart failure (McMurray et al. 2014).