DeVore AD, Braunwald E, Morrow DA, et al. - Researchers investigated patients recently hospitalized for acute decompensated heart failure (ADHF) and switching from taking enalapril to taking sacubitril/valsartan after discharge to determine the changes in N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels in these patients. In addition, they compared patients randomized to receive in-hospital initiation of sacubitril/valsartan vs in-hospital initiation of enalapril who later switched to taking sacubitril/valsartan with respect to their clinical outcomes during an open-label extension phase. They conducted a secondary analysis of PIONEER-HF, which is a multicenter, randomized, double-blind, active-controlled trial conducted at 129 US sites between May 2016 and May 2018. In PIONEER-HF, comparison of the in-hospital initiation of sacubitril/valsartan vs enalapril (titrated to target dose, 10 mg twice daily) for 8 weeks was performed among patients admitted for ADHF with reduced ejection fraction and hemodynamic stability. All participants were to proceed in a 4-week, open-label study of sacubitril/valsartan; 832 of 881 patients (94%) enrolled in PIONEER-HF continued in the open-label study. Patients who continued to take sacubitril/valsartan showed a decline in NT-proBNP levels by −17.2% from week 8 to 12. Those switching from taking enalapril to sacubitril/valsartan after the week 8 visit showed a greater decline in the NT-proBNP levels (−37.4%). This suggest the association of sacubitril/valsartan with further reductions in N-terminal pro–B-type natriuretic peptide levels compared with enalapril in patients recently treated for ADHF. Over the entire 12 weeks of follow-up, they noted a lower hazard for the composite outcome among patients that began taking sacubitril/valsartan in the hospital vs those initiating enalapril in the hospital and then having a delayed introduction of sacubitril/valsartan 8 weeks later.