NPPB and hydrops fetalis: While the PIONEER-HF trial, with a design similar to EMPULSE, focused on NT-proBNP levels rather than clinical outcomes (35), subsequent trials such as EMPULSE and TRANSITION have provided evidence supporting the safety of initiating chronic HF therapies, such as SGLT2 inhibitors and sacubitril-valsartan, respectively, during the index hospitalization (pre-discharge) (36, 37).