Restrictive Versus Liberal Fluid Intake in Acute Decompensated Heart Failure

Inclusion criteria

• Age >18 years
• Hospitalized for ADHF as the primary diagnosis, meeting both of the following:

• ≥1 documented symptom of new or worsening heart failure (dyspnea, fatigue, decreased exercise tolerance, or symptom of end-organ hypoperfusion).
• Objective evidence of ADHF, defined as either:

i. ≥2 physical signs (edema, ascites, pulmonary rales/crackles, increased JVP, S3 gallop, rapid weight gain due to fluid retention), OR ii. ≥1 physical sign AND ≥1 laboratory finding indicative of ADHF (BNP >500 ng/L or NT-proBNP >2000 ng/L if sinus rhythm, or BNP >750 ng/L or NT-proBNP >3000 ng/L if atrial fibrillation, radiological/ultrasound evidence of pulmonary congestion, echocardiographic sign [VCI >2.1 cm, LVOT VTI <15 cm, E/e' >14, D-dominant pulmonary venous inflow pattern], or invasive evidence [CVP >12 mmHg, PCWP >18 mmHg, CI <2.2 L/min/m2]).

• Treatment with ≥40 mg IV furosemide (or equivalent)
• Enrolment within 24 hours of admission
• Ability to provide informed consent

Exclusion criteria

• Requirement at admission for ICU-level care, or IV inotropic/vasopressor therapy for ADHF.
• Na+ <125 mmol/L or Na+ >145 mmol/L.
• End-stage chronic kidney disease on chronic dialysis or eGFR <15 mL/min/1.73 m2
• Any condition which would make participation unsafe or substantially affect protocol adherence, as judged by investigator.