In the PARADIGM trial, ARNI proved superior to ACEI in those with HFREF receiving ACEI/ARB, but there are many reasons for considering initiation of ARNI in ACEI naïve patients.

Safety and benefit of its use in acute HF before discharge, demonstration of benefits in those with high-risk clinical features and even in those who receive lesser doses, metabolic benefits in the form of lesser occurrence of hyperkalemia and better reduction of HbA1c, lesser rate of progression of renal disease, better diureticsparing effect and better outcome benefits in those with milder compared to advanced heart failure are enough reasons to consider early initiation of ARNI.